Technical Notes on Liver Elastography: A Guide for Use in Neonates in Intensive Care Units

Area of Science:

• Neonatal Medicine
• Medical Imaging
• Hepatology

Background:

• Liver elastography is a non-invasive, radiation-free technique for assessing liver stiffness.
• It offers quantitative elasticity measures, surpassing conventional ultrasound for diffuse liver diseases.
• Point-of-care liver elastography complements traditional ultrasound in intensive care settings.

Purpose of the Study:

• To outline critical milestones for performing point-of-care liver elastography in neonatal intensive care units (NICUs).
• To highlight the utility of elastography in evaluating various neonatal liver conditions.
• To address the challenges and best practices for elastography in neonates.

Main Methods:

• Utilizes point-shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE).
• Evaluates conditions including hypoxic-ischemic liver disease, cholestatic diseases, and metabolic disorders.
• Addresses challenges in neonates, such as sensitivity to stimuli and limited hepatic depth.

Main Results:

• Minimizing contact time, adjusting indices for biosecurity, and ensuring patient stability are key success factors.
• Sonoelastography has demonstrated clinical utility despite challenges in neonates.
• Standardized reference values are emerging, enhancing clinical applicability.

Conclusions:

• Liver elastography is a valuable tool in NICU settings for assessing liver stiffness.
• The technique aids in the diagnosis and management of various liver conditions in neonates.
• Ongoing research and standardization are improving its application in neonatal care.