Fetal Liver Volume and Morphology in Growth-Restricted Fetuses and Their Association With Neonatal Morbidity: An MRI Study.
Authors
Affiliations (15)
Affiliations (15)
- Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Sagol Brain Institute, Tel Aviv Sourasky University Medical Center (Ichilov), Tel Aviv, Israel.
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel.
- School of Neurobiology, Biochemistry and Biophysics, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel.
- Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky University Medical Center (Ichilov), Tel Aviv, Israel.
- Department of Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Sourasky University Medical Center (Ichilov), Tel-Aviv, Israel.
- Department of Biomedical Engineering, Technion-IIT, Haifa, Israel.
- May-Blum-Dahl Technion Human MRI Research Center, Technion-IIT, Haifa, Israel.
- Neonatal Intensive Care Unit, Dana Dwek Children's Hospital, Tel Aviv Sourasky University Medical Center (Ichilov), Tel Aviv, Israel.
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky University Medical Center (Ichilov), Tel Aviv, Israel.
- Department of Maternal-Fetal Medicine, Lis Maternity and Women's Hospital, Tel Aviv Sourasky University Medical Center (Ichilov), Tel Aviv, Israel.
- Department of Radiology, Tel Aviv Sourasky University Medical Center (Ichilov), Tel Aviv, Israel.
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
Abstract
Fetal growth restriction (FGR) may induce redistribution of the fetal circulation to preserve perfusion of vital organs. Reduced hepatic delivery of oxygen- and nutrient-rich blood may cause volumetric and morphological remodeling. To quantify fetal liver volume and morphology in FGR and assess associations with adverse neonatal outcomes. Single-center, prospective and retrospective. Ninety-two singleton pregnancies: 36 FGR cases (prospective) and 56 appropriate-for-gestational-age (AGA) controls (retrospective). 3-T, True Fast Imaging with Steady-State Free Precession (TrueFISP) for fetal liver and body imaging, and TrueFISP or Half-Fourier Acquisition Single-shot Turbo Spin-Echo for brain imaging. The fetal liver, body, and brain were segmented using deep learning tools. Liver volume, liver-to-body and brain-to-liver volume ratios, and 12 liver PyRadiomics shape features were assessed. Neonates were followed for composite adverse neonatal outcomes (CANO) until discharge. Linear regression assessed associations with gestational age in AGA fetuses. Linear mixed-effects models compared groups, adjusting for gestational age and fetal sex. Univariable logistic regression assessed associations with CANO. Benjamini-Hochberg correction controlled the false discovery rate at 0.05. FGR fetuses had significantly lower liver volume than AGA fetuses (74.95 ± 1.76 vs. 114.89 ± 2.18 cm<sup>3</sup>), lower liver-to-body ratio (0.053 ± 0.001 vs. 0.057 ± 0.001), and higher brain-to-liver ratio (2.637 ± 0.085 vs. 1.978 ± 0.047). FGR fetuses demonstrated significantly less elongated liver geometry, (10.7% higher PyRadiomics elongation values) and had a significantly higher surface-to-volume ratio (11.9%). CANO occurred in 30/92 neonates (27 FGR, 3 AGA). Higher brain-to-liver ratio (OR = 4.12, 95% CI: 1.93-8.77), PyRadiomics elongation values (less elongated geometry; OR = 2.04, 95% CI: 1.26-3.30), PyRadiomics flatness values (less flattened geometry; OR = 1.69, 95% CI: 1.07-2.65), and surface-to-volume ratio (OR = 3.26, 95% CI: 1.80-5.90) were significantly associated with CANO. FGR was associated with reduced fetal liver size and altered geometry, which were associated with neonatal morbidity. 2. 2.