Quantitative Shear-Wave Elastography of the Liver in Preterm Neonates with Intra-Uterine Growth Restriction
Marianne Alison1,2, Valérie Biran2,3, Anca Tanase1,2
1Department of Pediatric Radiology, Robert Debré Children University Hospital and Denis Diderot Paris University, APHP, 75019 Paris, France.
Insights
Supersonic Shear-wave Imaging (SSI) is a feasible and reproducible method for measuring liver stiffness in preterm infants. Intra-uterine growth restriction (IUGR) neonates show higher liver stiffness, potentially predicting cholestasis before clinical signs appear.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Medical Imaging
Background:
- Liver stiffness measurement in preterm neonates using Supersonic Shear-wave Imaging (SSI) has not been previously reported.
- Understanding liver stiffness variations in preterm infants, particularly those with intra-uterine growth restriction (IUGR) and cholestasis, is crucial for early diagnosis and management.
Purpose of the Study:
- To assess the feasibility and reproducibility of liver stiffness measurements in preterm neonates using SSI.
- To determine if liver stiffness differs between appropriate for gestational age (AGA) and IUGR preterm infants, with or without cholestasis.
- To investigate the correlation between liver stiffness and birth weight in preterm infants.
Main Methods:
- Liver stiffness was measured in 45 AGA and 18 IUGR preterm infants using SSI.
- Reproducibility was assessed using Intraclass Correlation Coefficients (ICC) and Bland-Altman analysis.
- Liver stiffness values were compared between AGA and IUGR groups, with and without cholestasis, and correlated with birth weight.
Main Results:
- SSI demonstrated high reproducibility for liver stiffness measurements in preterm neonates (intra-operator ICC = 0.94-0.98, inter-operator ICC = 0.86).
- IUGR preterm infants exhibited higher liver stiffness than AGA infants during the first postnatal week (7.50 ±1.53 kPa vs. 5.11 ±0.80 kPa, p<0.001).
- Liver stiffness increased significantly in IUGR infants after postnatal day 8 and was markedly higher in those with cholestasis (19.35 ± 9.80 kPa) compared to those without (7.72 ± 1.27 kPa, p<0.001).
Conclusions:
- Quantitative liver stiffness measurement using SSI is feasible and reproducible in preterm infants.
- Elevated liver stiffness is present at birth in IUGR neonates who subsequently develop cholestasis, suggesting its potential as an early predictive biomarker.
- SSI offers a promising non-invasive tool for assessing liver health in high-risk preterm populations.
Abstract:
The feasibility and reproducibility of liver stiffness measurements using Supersonic Shear-wave Imaging (SSI) in preterm neonate have not been reported. Our aim was to determine if liver stiffness differs between intra-uterine growth restriction (IUGR) and appropriate for gestational age (AGA) preterm infants with/without cholestasis. We measured liver stiffness (in kPa) in 45 AGA and 18 IUGR preterm infants, and assessed reproducibility in 26 preterms using Intraclass Correlation Coefficients (ICC) and Bland-Altman tests. Liver stiffness values were compared between AGA and IUGR with and without cholestasis and correlated with birth weight. Measurements showed high reproducibility (ICC = 0.94-0.98 for intra-operator, 0.86 for inter-operator) with good agreement (95% limits: -1.24 to 1.24 kPa). During the first postnatal week, liver stiffness was higher in IUGR (7.50 ±1.53 kPa) than in AGA infants (5.11 ±0.80 kPa, p<0.001). After day 8, liver stiffness remained unchanged in AGA but increased progressively in IUGR infants (15.57 ±6.49 kPa after day 21). Liver stiffness was higher in IUGR neonates with cholestasis (19.35 ± 9.80 kPa) than without cholestasis (7.72 ± 1.27 kPa, p<0.001). In conclusion, quantitative liver SSI in preterms is feasible and reproducible. IUGR preterms who will develop cholestasis present high liver stiffness even at birth, before biological cholestasis occurs.
