Ultrasound-derived fat fraction and automated point shear-wave elastography in diagnosing intrahepatic cholestasis of pregnancy and preeclampsia

Abstract Objective To evaluate the diagnostic value of Ultrasound-derived fat fraction (UDFF) and Automatic point Shear Wave Elastography (Auto pSWE) for intrahepatic cholestasis of pregnancy (ICP) and preeclampsia (PE). Methods This prospective study included 135 healthy pregnant women and patients with ICP and PE. Data collected included medical history, anthropometry, liver ultrasound, UDFF, Elastic Modulus (E), Shear Wave Velocity (SWV), and biochemical parameters. Each ICP or PE case was matched 1:1 with a healthy control by age (± 2 years) and gestational age (± 1 week). Differences in UDFF, Auto pSWE, and markers of liver and endothelial function were analyzed among ICP, PE, and healthy controls. The diagnostic value of UDFF and Auto pSWE was evaluated using univariate, correlation, and multivariate logistic regression analyses, and sensitivity, specificity, and optimal cutoffs were determined by ROC analysis. Results (1) Significant differences were observed between the ICP and PE groups and the control group in clinical indicators such as BMI, ALT, TBA, T-Bil, PT, and ALB ( P < 0.05).(2) UDFF, E, and SWV parameters showed significant differences between the ICP, PE, and control groups ( P < 0.01). E was identified as the preferred screening marker for ICP, with an optimal cutoff value of 7.471 kPa. UDFF and E were found to independently predict PE and could effectively differentiate between mild and severe PE. Conclusion UDFF and Auto pSWE non-invasively quantify hepatic fat and stiffness in pregnancy and demonstrate clinically useful accuracy for diagnosing and staging ICP and PE, supporting their role as quantitative screening tools.