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OznurL.Konu@1Ay@egüIOzdemirAlaaddinAkkayaGoncaErba@Had çelikSedatI@lk
OBJECTIVE. The objectiveof this studywas to determinethe normal rangeof dimensions for the liver, spleen, and kidney in healthy neonates, infants, and children.
SUBJECTS AND METHODS. This prospectivestudyinvolved307 pediatricsubjects(169 girls and 138 boys) with normalphysicalor sonographicfindingswho were examinedbecauseof problems unrelated to the measuredorgans.The subjects were 5 days to 16 yearsold. All measured organs were sonographically normal. At least two dimensions were obtamed for each liver, spleen, and kidney. Relationships of the dimensions of these organs withsex, age, body weight, height, and body surface area were investigated. Suggested limits ofnormal dimensions were defined.
RESULTS. Dimensionsof themeasuredorganswerenotstatisticallydifferentin boysandgirls.Longitudinaldimensionsof all threeorgansshowedthe bestcorrelationwith age,bodyweight, height, and body surface area. Height showed the strongest correlation of all. Thiscorrelationwasa polynomialcorrelation.
CONCLUSION. Determinationof pathologicchangesin sizeof theliver,spleen,andkidney necessitates knowing the normal range of dimensions for these organs in healthy neonates,infants, and children. Presented data are applicable in daily routine sonography. Body height
should be considered the best criteria to correlate with longitudinal dimensions of these organs.
S onography provides a quick assessment of visceral organ di
mensions without any risk ofradiation. The normal range of visceral organsizes in adults and children determined with
sonography has been reported elsewhere [ I—¿�13]. However, available data are limited forthe liver and the spleen in children, whichcauses difficulty in defining hepatomegalyand splenomegaly sonographically.
Our purposewas primarily to documentthe normal range of dimensions of the liverin children. The relationship of each dimensionwith sex,age,body weight, height,andbody surface area was determined. A similarevaluation was done for the spleen and thekidney at the same time.
We prospectively examined 307 pediatric sub
jects ( 169 girls and 138 boys) with sonography. The
rangeof agewasfromfull-termnewborns(5 days)to 16 years. Patients who did not have normal
growth curves (who were not in the third to 97thpercentiles)were not includedin the study.Anothermajor criterion for selection of children was having
no clinically or sonographically pathologic findings
related to the studied organs. Most children were
completely healthy. although some were undergoing follow-up for a disease unrelated to the measured organs, such as hip dysplasiaor undescendedtestes. No child had a history of oncologic, hemato
logic, or traumatic conditions. Some children with
urinarytract infectionwereincludedin the study,butonly liverandspleendimensionswererecordedinthosepatients.Wealsodidnotrecorddimensionsof a number of spleens for which abdominal gas
distentionpreventedreliablesize measurements.Allmeasuredorganshada normalpositionandshapeand normalecho texture.
We used high-resolution real-time sonographic
scanners (SSA 270A; Toshiba, Tokyo, Japan; and
EUB-5l5 and EUB-5l5A; Hitachi, Tokyo, Japan)with 3.5-MHz convextransducers.Patientshadneither preparation nor sedation.
Liver measurements were performed in all sub
jects(n= 307).In asubjectlying in thesupineposition, longitudinaland anteroposteriordimensionswereobtainedin themidclavicularandmidsagittal
ReceivedMarch30,1998;acceptedafterrevisionJune17,1998.
1All authors: Department of Radiology, School of Medicine,GaziUniversity,Besevier,06510,Ankara,Turkey.Address Subjects and Methodscorrespondenceto 0. L Konu@.
AJR1998;1711693—1698
0361—803X/98/1716—1693
©AmericanRoentgenRaySociety
AJR:171,December1998 1693
Normal Liver, Spleen, and KidneyDimensions in Neonates, Infants,and Children: EvaluationwithSonography
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Height.85.77.81.50Age.82.71.78.47Weight.80.73.74.49Surface
area.83.75.78.45
BodyParameterLongitudinalTransverseHeight
AgeWeight
Surfacearea.88
.84
.84
.86.70
.67
.69
.70
Posterior Anterior
__________Correladon Coefficients for I,1q@@Kidney Dimensions as
Revealedby Sonographyin F279 PediatrIc Subjects j
BodyParameterRightKidneyLeftKidney@Long.
Trans.Long.Trans.Height.94
.86.93.85E@Age.91
.84.90.83Weight.89
.82.88.79Surface
area.91.83.91.80Note—Long.=longitudinal,Trans.=transverse.
(7IuI:@Right@ Left
Konu@etal.
planes for the right and left lobes. “¿�Midsagiualplane―means that the plane passes through thexiphoid process. In both planes, the upper margin ofthe liver was defined as the uppermost edge underthe dome of the diaphragm, whereas the lower margin was defined as the lowermost edge of the lobe(Fig. 1).
Spleen measurements were performed in 169girls and 130 boys (n = 299). Longitudinal andtransverse dimensions in the coronal plane wereobtained with the subject in the supine or slightlyrightlateraldecubitusposition.Longitudinalsizemeasurement was performed between the most superomedial and the most inferolateral points of thespleen. The transverse dimension was measuredbetween the hilum and the most superolateral margin ofthe spleen (Fig. 2).
Kidney measurements were performed in 155girlsand 124boys(Fl= 279). Longitudinalandtransverse dimensions of both kidneys were obtamedinthecoronalplanepassingthroughtherenal hilum with subjects in the supine or slightlyrightor leftlateraldecubituspositions(Fig.3).
To determine reproducibility. each measurement of each organ was repeated at least threetimes, and the most repeated value was recorded.Data obtained from the measurements were classifled into I I age groups. Relationships of all dimensions with sex, age. height. weight. and bodysurface area were statistically analyzed. Body surface area was derived using the patient's heightand weight from the nomogram modified from thedataof E. Boydby C. D. WestI 141.All measurements were plotted as a function of age in months,body weight, height, and body surface area. Typesof relationships and regression lines were obtainedfor the various sets of data using the least squaresmethod. The mean. minimum, and maximumvalue; fifth and 95th percentiles: and standard deviationswerecalculated(Excel5.0: Microsoft.Redmond, WA). The lowermost and uppermostlimitsof normalfor eachagegroupweresuggested and were derived using the previous zero orfive integer values below the fifth percentile, and
the next zero or five integer values above the 95thpercentile, considering also the mean, minimum,and maximum values of normal [I 1.
Results
No statistically significant differences werefound betweenthe two sexesin any agegroupfor any measured organ dimension (t test, p>.05).Therefore, all datawere rearrangedwithout being separatedaccording to sex.
Compared with the anteroposterior and
transverse dimensions, all longitudinal di
mensions of each organ showed the highest
correlation with the body parameters(i.e.,age, height, weight, and body surface area)
(Tables 1—3).Among the body parameters,height was the one best correlated with thelongitudinal dimension of each organ. Bodysurface area, age, and weight followedheight, in that order. Correlation coefficientsare presented in Tables 1—3.On regressionanalysis, the relationship between the longitudinal dimensions and height was of thepolynomial type for each organ (Figs. 4—8).
Longitudinal dimensions of the right lobeof the liver, the spleen, and both kidneys,with corresponding values of patient heightin selected age groups, are presented in Tables 4-7. Mean, minimum, and maximumvalues; fifth and 95th percentile values; standard deviations; and suggestedlimits of normal are also given. Other dimensions arepresented in graphic form (Figs. 4—8).Thedimensions of the left lobe of the liver, except those taken in infancy, poorly correlatedwith body parameters.
Significant differenceswere found betweenthe longitudinal sizes of the right and left kidneys (t test, p < .05). For this reason, findings
Jver I Imenslons asRevealed by Sonography In
I Pediatric Subjects
RightLobe Left LobeBodyParameter
Long. AP Long. AP
Note—Long.=longitudinal,AP=anteroposterior.
;orrelatlonCoefficientsforpleen Dimensions as
Revealedby SonographyIn9 PediatrIcSubjects
A BFig.1.—Diagramsshowhowlongitudinalandanteroposteriordimensionsofliverlobesweremeasured. Fig.2.—DiagramshowshowIonA,Livermeasurementswereperformedatmidclavicularandmidlinesagittalplanes. gitudinalandtransversedimenB,Longitudinalandanteroposteriordimensionsof rightandleftlobesweremeasured. sionsofspleenweremeasuredin
coronal section passing throughsplenichilum.
Fig.1—Diagramshowshow longitudinalandtransversedimensionsof kidney were measuredincoronalsectionpassingthrough renalhilum.
1694 AJR:171,December 1998
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0 20 40 60 80 100 120 140 160 180 200
Height(cm)
120j—-••—@——.@—100
@ .-@. . .@ 4@ ..—@
ght(cm)Hei
EEa..a,C•¿�C
.C@,
0 20 40 0 20 40 60 80 100 120 140 160 180 200
Height(cm)
60 80 100120Height
(cm)140 160 180 200
Sonography of Liver, Spleen, and Kidney Dimensions in Children
Fig.4.—Scatterdiagramshows longitudinal(•)and anteroposterior (0)dimensions of right lobeof liver plotted againstheights of patients. Notethat longitudinal dimensions of right lobe arelonger than anteropostenor dimensions and thisdifference increaseswithheight.
for the right and left kidneysarepresentedseparately in Tables 6 and 7 and in Figures 7 and 8.
Discussion
In the literature, studies about normal liverand spleen dimensions in children are rare,especially for the liver. Most studies do not
organs without the risk of ionizing radiation.Organ volumes or ratios obtained by usingvarious organ dimensions and body surface areas are already used in correlation with bodyparameters to describe the normal dimensionsandto measurethe degreeof pathologic deviation from normal. However, those techniquesare time-consuming and impractical in dailyuse. On the other hand, either one or more ofthe longitudinal, anteroposterior, and transversedimensionsof theseorgansaremeasuredaspart of routine abdominalsonographicscanning. Therefore, use of these measurementsseems more practical for purposes of determining “¿�normal:'Any other data, when neces
sary to combine with the above measurements,
should also be easily obtainable. Age, bodyweight, andheight aresuchparameters.
We did not find any significant differencein measured organ sizes between the twosexesof any age group (t test, p > .05). Thisfinding is similar to the findings of others [2—7, 10—12].Therefore, sex certainly is not a
120 200
Height(cm)
include enough children to separate the sub
jects into appropriate age groups [1—9].Westudied many children of all ages, and to our
knowledge, this study covers the largest series of pediatric liver and spleendimensions.
Sonographyis a simpleandreliableway tovisualize and to measure abdominal visceral
Fig.5.—Scatterdiagramshowslongitudinal(•)andanteroposterior(o) dimensions of left lobe of liver plotted against heights of patients. Note that longitudinaldimensions of left lobe are shorter than anteroposterior dimensions at patientheightsof lessthan 70cm but longer at patient heightsof morethan 70cm.
Fig.6.—Scatterdiagramshowslongitudinal(•)andtransverse(0) dimensionsofspleenplottedagainstheightsofpatients.
Fig.1.—Scatterdiagramshowslongitudinal(•)andtransverse(o) dimensionsofright kidneyplotted againstheightsof patients.
Fig.8.—Scatterdiagramshowslongitudinal(•)andtransverse(0) dimensionsofleft kidneyplottedagainstheightsof patients.Leftkidneydimensionsarelongerthanrightkidneydimensions,asseenincomparisonwithFigure7.
AJR:171,December1998 1695
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BodyHeight(cm)No.Age
Range(mo)MeanSD.
.Minimum. MaximumPercentileSuggested
LimitsofNormal5th95thLowermostUppermost47—64
54—7365—78
71—92
85—109
100—130110—131
124—149
137—153
143—168
152—17553
402018
27
3038
30
16
23
121—3
4—67—912—30
36—59
60—8384—107
108—131
132—155
156—179
180—20064
737985
86
100105
105
115
118
12110.4
10.88.010.0
11.8
13.610.6
12.5
14.0
14.6
11.745
446867
69
7381
76
93
87
10090
92100104
109
125128
135
137
137
14148
537068
63
7790
83
95
94
10482
869098
105
124123
128
136
136
13940
456065
65
7075
75
85
85
9590
95100105
115
125130
135
140
140
145L.ongitu4l
SubjectsInal
Dimen‘ons ofSplei Versus Height and Age
LongitudinalDimensions(mm)ofSpleenBody
Height(cm)No.Age
Range(mo)MeanSD.
.Minimum. MaximumPercentileSuggested
LimitsofNormal5th95thLowermostUppermost48—64
54—73
65—7871—9285—109
100—130110—131
125—149
137—153
143—168
152—17552
39
181827
3036
29
17
21
121—3
4—6
7—912—3036—59
60—8384—107
108—131
132—155
156—179
180—20053
59
637075
8485
86
97
101
1017.8
6.3
7.69.68.4
9.010.5
10.7
9.7
11.7
10.333
45
505460
6165
64
72
84
8871
71
778691
100102
114
100
120
12040
47
535561
7069
70
81
85
8865
67
748288
100100
100
108
118
11530
40
455055
6065
65
75
80
8570
75
808595
105105
110
115
120
120
@I•LongltudSubjects@nal
Dimen@ronsof RightKidney VersusHeight andAgeLongitudinal
Dimensions(mm)of RightKidneyBody
Height(cm)No.Age
Range(mo)MeanSD.
.Minimum. MaximumPercentileSuggested
Limits ofNormal5th95thLowermostUppermost48—64501—3505.838664058356554—73394—6535.341665064407065—78177—9595.250705266457071—921812—30613.455665565507585—1092236—59675.1577759755580100—1302660—83745.5628365836085110—1313284—107806.6689370916595124—14927108—131807.06996698965100137—15315132—155896.2811028210070105143—16822156—179945.9831058510275110152—17511180—200927.0801078310275110
Konu@etal.
ILongitudinalDimensionsofRightLobeofUverVersusHeightandAgeSubjects LongitudinalDimensions(mm)of RightLobeof Liver
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•¿�I@1:1@@LongItudInaIDimensionsof Left KidneyVersusHeight andAgeSubjectsLongitudinal
Dimensions (mm) of LeftKidneyBody
Height(cm)No.Age
Range(mo)MeanSD-
-Minimum. MaximumPercentileSuggested
LimitsofNormal5th95thLowermostUppermost48—64
54—7365—78
71—9285—109
100—130
110—131
124—149
137—153
143—168
152—17550
3917
1822
26
32
27
15
22
111—3
4—67—9
12—3036—59
60—83
84—107
108—131
132—155
156—179
180—20050
5661
6671
79
84
84
91
96
995.5
5.54.6
5.34.5
5.9
6.6
7.4
8.4
8.9
7.539
4454
5461
66
71
71
71
83
8761
6868
7577
90
95
99
104
113
11642
4754
5761
70
73
75
77
84
9059
6468
7276
87
93
97
102
110
11035
4045
5055
60
65
65
70
75
8065
7075
8085
95
100
105
110
115
120
Sonography of Liver, Spleen, and Kidney Dimensions in Children
determining factor for organ dimensions inthe pediatric agegroup.
In most other studies, sizes between thefifth and the 95th percentile were the accepted normal limits [2, 3, 5, 6, 8—10,13].However, this practice results in approximately 10% of children with normal visceralorgan sizes falling outside these limits [1 1].Besides, although plus or minus two SDs arethe accepted equivalents of the fifth and 95thpercentile values statistically [15], somestudies were basedon plus or minus one SD[7]. For this reason,we preferredto definethe normal lowermost and uppermost longitudinal dimensions of the studied organs using the method originally described by
Rosenberget al. [ 11in 1991.We foundthatheightshowsthebestcorre
lation with any one of the mentioned organdimensions. Body surface area also shows ahigh correlation with organ dimensions, butto a lesser degree. However, its derivation isnot as practical as height. For those reasons,we preferred not to use body surface area instandard tables and graphics. Age and bodyweight are not as important as height andbody surface area.Therefore, when decidingif sonographically obtained dimensions of anorgan are normal, patient height should bethe primary concern.
The liver is an organ of complex shapeand varies widely from patient to patient.Our wide range of normal dimensionssupports this opinion. However, it is necessaryto have references for normal liver dimensions in the pediatric age group.
The findings of various similar studiesdiffer somewhat from eachother and from ours.Deligeorgis et al. [12] performed a study with
direct roentgenography in 350 children to establish normal liver dimensions. They foundsignificantly longer dimensions than we did.The reason for the difference is obviously themagnification factor on radiographs.
Somefindings arecontradictoryevenwithinonestudy.Forexample,in thestudyof Holderetal. [2], which included 185children,sonographically measureddimensionsof the liver are anaverageof 4 cm smaller than the samedimensions measured scintigraphically. Our sonographicallymeasuredliver dimensionsarelargerthan those of Holder et al. The reason is probably their techniqueof measurement.They usedlinear transducersand performed the measurements in a sagittal plane passing through themidpoint of the liver's right and left margins.Linear transducers,becauseof the interpositionof lung betweenthe dome of the liver and theanteriorabdominalwall, preventsomeof thesuperior portion of the liver from being observed.This effect,asHolder admits,resultsin the “¿�observed―lung—liverborder'sbeingdeterminedasthe superior margin of the liver, and consequently in the liver's being measuredashavingsmaller longitudinal dimensions than the liverswe measured.Convex probes,such as the onewe used, prevent this complication. Besides, unlike Holderet al.,we believethatthemidpoint ofthe liver's right and left margins cannot be re
ferred to as a standard sagittal plane because the
left lobe in particular differs in extensionandsize from one personto anotherand with age.Instead, midsagittal and midclavicular planesseem more appropriate for longitudinal liver size
measurements. In spite of these technical differ
ences, Holder et al. also concluded that height isthe best-correlatedbody parameterwith liverlongitudinal dimensions.
In the study of Markisz et al. [4] that included 116 children, liver and spleen dimensions obtained with scintigraphic methods
also exceeded ours. Those authors used volume measurements and found a high linearcorrelation between the volumes of theseorgans and patient weights. Correlations with
age were lessevident. Patient height or organdimensionswere not consideredin their studyand limits of normal cannot be derived. Fromthe study of Markisz et al. (like the study ofHolder et al. [2]), we conclude that scinti
graphically obtained organ sizes are largerthan sonographically obtained ones. Therefore, differences in organ size are probablydue to the difference of imaging techniques.
In 1983, Niederau et al. [13] described astudy of normal liver dimensions in 1000adult patients. Sonographically, their studyshowed smaller values than ours. This difference is probably the result of the sametechnical reason we discussed with respect to thestudy of Holder et al. [2]. Niederau et al.noted that organ sizes increased with heightand body surface area in adults.
In 1983, Dittrich et al. [3] also usedsonography to study liver dimensions in 194children. Although they reported smaller dimensions than we did, Dittrich et al. notedthe best correlation was found between liverdimensions and height, which is a linear correlation. They found also a high correlation
with body surface area, but in their studyonly height was used as a reference parameter for further analysis.
Normal spleen dimensions and volumestandards have been investigated by only afew researchers.Rosenberget al. [1] studiednormal spleen longitudinal dimensions in
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8). This finding is similar to the findings ofDinkel et al. [10]. In the infancyperiod,theanteroposterior dimension of the left lobe ofthe liver may be somewhat longer than thelongitudinal dimension. With aging, thesephenomena change and the longitudinal dimension of the left lobe becomes longer than
the anteroposteriordimension except inobese persons [13]. We observed the samephenomenon in infants. Anteroposterior dimensionsof theleft liver lobeswerefoundtobe somewhat longer than the longitudinal dimensions. The reason is that the intraabdominal visceral organs are larger in childrenthan in adults when compared with totalbody volume. This finding leads to the conclusion that measurements of the midclavic
ular and midsagittal longitudinal dimensionssuffice to estimate the liver size in most children, and that measurements of anteroposterior dimensions, particularly of the left lobe,must be obtained only in infants.
Data of normal visceral organ sizes according to age have been given in table form in
several previous studies [1, 7]. However, theselected age groups in those studies present awide range like 5 years, as in the studies ofRosenberg et al. [1] and Dremsek et al. [7]
(whereas our selected age groups had an age
range of 3 months or 2 years). In other studies,
data were given only in graphic form [2—6,10]. We present our data both in tabular andgraphic forms with the aim ofenabling a morepractical evaluation during a sonographic examination.
Establishing normal parameters is mandatory for defining the pathologic changes insize of the liver, spleen, and kidneys in routine sonographic examinations of children.
The methodsof measurementand analysiswe used in this study are standardizedandeasy to apply. Findingsare handy and reliable and are suitable particularly for sonography units and pediatric departments withlarge numbers of patients.
Longitudinal dimension and patient heightare the most important determining factors oforgan size among studied dimensions andbody parameters. Therefore, any specificlongitudinal dimension should primarily becorrelated with patient height, and findings
should be compared with tables and graphicsof normal parameters.
References1. RosenbergHK, MarkowitzRI, KolbergH, Park
C, HubbardA, BellahRD.Normalsplenicsizeininfantsand children:sonographicmeasurements.AiR 1991;157:119—121
2. Holder L, Strife J, Padikal TN, Perkins PJ, KerelakesJG. Liversize determinationin pediatricsusing sonographic and scintigraphic techniques.Radiology1975;!17:349—353
3. Dittrich M, Milde S. Dinkel E, Baumann W,Weitzel D. Sonographic biometry of liver andspleen size in childhood. Pediatr Radiol 1983;13:206—211
4. Markisz JA,TrevesST.Davis RT Normal hepaticand splenic size in children: scintigraphic determination.PediatrRadiol 1987;17:273—276
5. Christophe C, Cantraine F, Bogaert C, et al. Ultra
sound: a method for kidney size monitoringinchildren. EurJ Pediatr 1986;145:532—538
6. Han BK, Babcock DS. Sonographic measurements and appearance of normal kidneys in children.AJR1985;145:611—616
7. Dremsek PA, Kritscher H, BöhmG, Hochberger0. Kidneydimensionsin ultrasoundcomparedtosomatometric parameters in normal children. PediatrRadiol 1987;17:285—290
8. RosenbaumDM, KorngoldE, TeeleRL. Sonographic assessment of renal length in normal chilthen.AJR1984;142:467—469
9. SchlesingerAE,EdgarKA,BoxerLA.Volumeofthe spleenin childrenas measuredon CT scans:normal standards as a function of body weight.AJR 1993;160:1107—l109
10. DinkelE, ErtelM, DittrichM, PetersH, BerresM,Schulte-WissermannH. Kidneysizein childhood:sonographicgrowthchartsfor kidneylengthandvolume. PediatrRadiol 1985;15:38—43
11. Zerin JM, Blanc CE. Sonographicassessmentofrenal length in children: a reappraisal. PediatrRadiol 1994;24:l0l—106
12. Deligeorgis D, YannakosD, Doxiadis S. Normalsize of liver in infancy and childhood: x-raystudy.ArchDis Child1973;48:790—793
13. Niederau C, Sonnenberg A, Muller JE, Erckenbrecht JF, ScholtenT, FritschWE Sonographicmeasurements of the normal liver, spleen, pancreas,and portal vein. Radiology 1983;149:537—540
14. Berhman RE, Kliegman R. Nelson essentialsofpediatrics. Philadelphia: Saunders, 1990:712
15. Remington 1W, Schork MA. Statistics with application to the biological and health sciences, 2nded. Englewood Cliffs, NJ: Prentice Hall, 1985:23—43
230 children using sonography.Interestingly,their dimensions are smaller than ours forchildren under the age of 8 years, whereas inchildren over the age of 8 years, the findingsof their study and ours are similar. Theystated that body weight showed the best correlation with spleen length, which was
roughly logarithmic in type. Height and age,in that order, were less well correlated withspleen length.
Schlesinger et al. [9] studied normal spleenvolume in 48 children using CT. These re
searchersfoundthatspleenvolumecorrelatedbetter with body weight than with age. Thebest regressionmodel was a simple linear relationshipof spleenvolumeto bodyweight.
Renal dimensions, as well as cross-sectional areas and volumetric standards of thekidneys, have been investigated by many different authors for pediatric age groups.
Christophe et al. [5] measured kidney
sizes sonographically in 170 children. Valuesof longitudinal kidney dimensionsin theirstudy are also similar to ours. These researchers found a linear relationship betweenrenal length and height. Additionally, theyfound that the longitudinal dimension of thekidneys versus body surface area yielded the
most accurate correlation. However, as theystated, correlating renal length with bodyheight is more practical.
In 1985, Dinkel et al. [10] studied renal dimensions and volumes in 325 children withsonographyandprovidedseparategraphicsforthe right and left kidneys. Correlations of renaldimensionswith body parametersin that studyare similarto our findings,and thoseauthorsstatedthat renal length showeda high correlation with body height. However, in their study,the correlation was a linear relationship. Theseresearchers also found that renal volumeshowed the best correlation with body surfaceareaand showedalmostthe samecorrelationwith body weight. For practicalpurposes,however, they proposed to use the correlation of renalvolumewithbodyweight.
We observed that the increase in the longitudinal dimensions of these organs is much
more rapid during the first years of life,which mirrors the accentuated body growthduringinfancyandearly childhood(Figs.4—
AJR:171,December19981698
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