The utility of MRI for measuring hematocrit in fetal anemia

Am J Obstet Gynecol. 2020 Jan;222(1):81.e1-81.e13. doi: 10.1016/j.ajog.2019.07.016. Epub 2019 Jul 12.


Background: Doppler ultrasound measurements of the peak systolic velocity of the middle cerebral artery can be used to noninvasively diagnose fetal anemia but are less precise following fetal blood transfusion and in late gestation. We have previously demonstrated the feasibility of estimating fetal hematocrit in vitro using magnetic resonance imaging relaxation times. Here we report the use of magnetic resonance imaging as a noninvasive tool to accurately detect fetal anemia in vivo.

Objectives: This study has 2 objectives: (1) to determine the feasibility and accuracy of magnetic resonance imaging in estimating hematocrit in anemic fetuses and (2) to compare magnetic resonance imaging and middle cerebral artery Doppler in detecting moderate to severe fetal anemia.

Study design: Fetuses undergoing fetal blood sampling or transfusion underwent magnetic resonance imaging examinations prior to and following their procedures at 1.5 Tesla (Siemens Avanto). A modified Look-Locker inversion pulse sequence and T2 preparation sequence were applied for T1 and T2 mapping of the intrahepatic umbilical vein. Estimated fetal hematocrit was calculated using a combination of T1 and T2 values and compared with conventional hematocrit obtained from fetal blood samples and middle cerebral artery Doppler measurements.

Results: Twenty-three fetuses were assessed during 33 magnetic resonance imaging scans. The mean absolute difference between the laboratory and magnetic resonance imaging-estimated hematocrit was 0.06 ± 0.05 with a correlation of 0.77 (P < .001) determined by a multilevel, mixed-effects model adjusting for the repeated measurements from the same participants, multiple gestation pregnancies, and the scan type (ie, before or after transfusion scan). Bland-Altman analysis revealed a systematic bias of -0.03 between the magnetic resonance imaging and fetal blood sampling measurements. Magnetic resonance imaging and middle cerebral artery Doppler had similar sensitivities of approximately 90% to detect moderate to severe anemia. However, magnetic resonance imaging had a higher specificity (93% [13/14], 95% confidence interval, 66-100%) than Doppler (71% [10/14], 95% confidence interval, 42-92%).

Conclusion: Moderate to severe fetal anemia can be detected noninvasively by magnetic resonance imaging with high sensitivity and specificity. Our results suggest an adjunct role for magnetic resonance imaging in fetuses with suspected anemia, particularly following previous transfusion and in late gestation.

Keywords: T(1) mapping; T(2) mapping; fetal hematocrit; fetal magnetic resonance imaging; longitudinal relaxation time; magnetic resonance imaging relaxometry; transverse relaxation time.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anemia / diagnosis
  • Anemia / diagnostic imaging*
  • Anemia / therapy
  • Blood Flow Velocity
  • Blood Group Incompatibility / complications
  • Blood Transfusion, Intrauterine
  • Cross-Sectional Studies
  • Female
  • Fetal Blood / metabolism
  • Fetal Diseases / diagnosis
  • Fetal Diseases / diagnostic imaging*
  • Fetal Diseases / therapy
  • Fetofetal Transfusion / complications
  • Fetofetal Transfusion / therapy
  • Hematocrit*
  • Humans
  • Magnetic Resonance Imaging
  • Middle Cerebral Artery / diagnostic imaging*
  • Pregnancy
  • Prospective Studies
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Ultrasonography, Doppler