TY - JOUR
T1 - Intrauterine blood transfusion causes dose- and time-dependent signal alterations in the liver and the spleen on fetal magnetic resonance imaging
AU - Schwarz, Michael
AU - Schmidbauer, Victor Ulrich
AU - Malik, Jakob
AU - Nowak, Nikolaus Michael
AU - Kienast, Patric
AU - Watzenboeck, Martin
AU - Stuempflen, Marlene
AU - Schwarz, Caroline
AU - Kittinger, Jakob
AU - Bettelheim, Dieter
AU - Haberl, Christina
AU - Binder, Julia
AU - Kiss, Herbert
AU - Reiberger, Thomas
AU - Prayer, Daniela
AU - Kasprian, Gregor
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2025/3
Y1 - 2025/3
N2 - BACKGROUND: Intrauterine transfusions (IUTs) are a life-saving treatment for fetal anemia. However, with each transfusion, iron bypasses uptake regulation through the placenta and accumulates in fetal organs. Unlike other imaging modalities, fetal magnetic resonance imaging (MRI) is capable of non-invasively assessing fetal liver disease and/or organ iron overload. This study aimed to investigate the effects of IUTs on MRI findings in the fetal liver and spleen.STUDY DESIGN: For this retrospective study, we included eight fetuses undergoing IUT and prenatal MRI from 2014 to 2023. The fetuses were gestational age-matched with a cohort that received fetal MRI for other indications, but no IUTs. Signal intensity (SI) and volumetric analyses of the liver and the spleen were performed.RESULTS: Fetuses receiving transfusions had significantly larger volumes of both liver (p = 0.003) and spleen (p = 0.029). T1 SI inversely correlated with the number of IUTs (Pearson's r = -0.43, p = 0.099). This effect regressed over time (r = 0.69, p = 0.057). T2 SI did not correlate significantly with transfusion frequency but showed a strong positive correlation with the number of days between IUT and MRI (r = 0.91, p = 0.002). For splenic SI measures, similar effects were observed regarding T1 SI reduction per received transfusion (r = -0.36, p = 0.167) and recovery of T2 SI after IUT (r = 0.88, p = 0.004).CONCLUSION: This is the first study to report the effects of IUTs on MRI data of fetal livers and spleens. We observed considerable dose- and time-dependent SI alterations of the liver and spleen following IUT. Furthermore, fetal hepatosplenomegaly can be expected following IUT.KEY POINTS: Question What fetal changes are found by MRI after life-saving intrauterine transfusion (IUT)? Findings Dose- and time-dependent reductions in signal intensity of the fetal liver and spleen, as well as hepatosplenomegaly, were found after intrauterine transfusion. Clinical relevance Intrauterine transfusions cause transient iron overload with consequential changes in MRI signal intensity of fetal livers and spleens. Fetal hepatosplenomegaly can be expected following transfusions. Radiologists' awareness of changes following IUT may improve report quality.
AB - BACKGROUND: Intrauterine transfusions (IUTs) are a life-saving treatment for fetal anemia. However, with each transfusion, iron bypasses uptake regulation through the placenta and accumulates in fetal organs. Unlike other imaging modalities, fetal magnetic resonance imaging (MRI) is capable of non-invasively assessing fetal liver disease and/or organ iron overload. This study aimed to investigate the effects of IUTs on MRI findings in the fetal liver and spleen.STUDY DESIGN: For this retrospective study, we included eight fetuses undergoing IUT and prenatal MRI from 2014 to 2023. The fetuses were gestational age-matched with a cohort that received fetal MRI for other indications, but no IUTs. Signal intensity (SI) and volumetric analyses of the liver and the spleen were performed.RESULTS: Fetuses receiving transfusions had significantly larger volumes of both liver (p = 0.003) and spleen (p = 0.029). T1 SI inversely correlated with the number of IUTs (Pearson's r = -0.43, p = 0.099). This effect regressed over time (r = 0.69, p = 0.057). T2 SI did not correlate significantly with transfusion frequency but showed a strong positive correlation with the number of days between IUT and MRI (r = 0.91, p = 0.002). For splenic SI measures, similar effects were observed regarding T1 SI reduction per received transfusion (r = -0.36, p = 0.167) and recovery of T2 SI after IUT (r = 0.88, p = 0.004).CONCLUSION: This is the first study to report the effects of IUTs on MRI data of fetal livers and spleens. We observed considerable dose- and time-dependent SI alterations of the liver and spleen following IUT. Furthermore, fetal hepatosplenomegaly can be expected following IUT.KEY POINTS: Question What fetal changes are found by MRI after life-saving intrauterine transfusion (IUT)? Findings Dose- and time-dependent reductions in signal intensity of the fetal liver and spleen, as well as hepatosplenomegaly, were found after intrauterine transfusion. Clinical relevance Intrauterine transfusions cause transient iron overload with consequential changes in MRI signal intensity of fetal livers and spleens. Fetal hepatosplenomegaly can be expected following transfusions. Radiologists' awareness of changes following IUT may improve report quality.
KW - Humans
KW - Female
KW - Spleen/diagnostic imaging
KW - Magnetic Resonance Imaging/methods
KW - Liver/diagnostic imaging
KW - Retrospective Studies
KW - Pregnancy
KW - Blood Transfusion, Intrauterine/adverse effects
KW - Prenatal Diagnosis/methods
KW - Adult
KW - Fetal Diseases/diagnostic imaging
UR - https://www.scopus.com/pages/publications/85212122401
U2 - 10.1007/s00330-024-11228-y
DO - 10.1007/s00330-024-11228-y
M3 - Journal article
C2 - 39663265
SN - 0938-7994
VL - 35
SP - 1605
EP - 1614
JO - European Radiology
JF - European Radiology
IS - 3
ER -