Ultrasound elastography of the neonatal brain: Preliminary study

Objectives - To determine the ultrasound elasticity of the brain in neonates Methods - Strain elastography was performed in 21 healthy neonates (mean gestational age [GA], 34 weeks; range, 28-40 weeks). Elastographic scores were assigned to the following structures on a 5-point color scale (1-5): ventricle, periventricular white matter, caudate, subcortical, cortical gray matter, and subdural space. Three elastographic images were evaluated in each patient, and median elastographic scores were calculated. The scores were compared between regions and were correlated with the corrected GA. Interobserver agreements for assignment of elastographic scores were analyzed. Results - The ventricle and subdural space showed an elasticity score of 1 in all patients. The cortical gray matter (median, 3.0; first-third quartiles, 2.33-3.33) showed higher elasticity compared to the periventricular white mater (4.0; 3.00- 4.00; P<.001), caudate (4.3; 3.67-4.67; P<.001), and subcortical white matter (4.0; 4.00-4.00; P<.001). The caudate showed lower elasticity compared to periventricular white matter (P=.004). The periventricular white matter showed higher elasticity compared to subcortical white matter (P=.009). There was a positive trend between the corrected GA and cortical gray matter elastographic score (γ=0.376; P=.093). Interobserver agreement was moderate to almost perfect (κ=0.53-0.89). Conclusions - Neonatal intracranial regions showed different elasticity, which could be accessed by strain elastography. These normal findings should prompt future studies investigating the use of ultrasound elastography in the neonatal brain.