Fetal Magnetic Resonance Imaging Detection of Liver Iron Deposition in Neonatal Hemochromatosis During Prenatal Therapy
Fetal Magnetic Resonance Imaging Detection of Liver Iron Deposition in Neonatal Hemochromatosis During Prenatal Therapy
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新生儿血色病产前治疗中肝脏铁沉积的胎儿磁共振成像检测
DOI：
10.1097/mpg.0000000000001265
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Yamaguchi K.
中科院分区：
文献类型：
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作者：
Sasaki A1;Motomura K;Suyama F;Nagasawa J;Hisano M;Ito R;Miyazaki O;Nakazawa A;Ito Y;Kasahara M;Asai A;Matsumoto K;Sago H;Yamaguchi K.
致编辑：妊娠期同种免疫性肝病（NH-GALD）引起的新生儿血色素沉着症可通过母体静脉注射免疫球蛋白（IVIG）得到改善（1）。然而，我们没有临床标记物用于宫内监测NH-GALD引起的胎儿肝损伤。一名36岁的日本妇女，其新生儿在出生后17小时死亡，这是2年前临床和组织学证实的NH-GALD的结果，她咨询了我院。在她下一次怀孕期间，她根据先前的方案从14周开始接受IVIG（2）。在38周时，我们使用2种胎儿磁共振成像（MRI）方法来评估胎儿肝脏状况（3，4）。首先，我们在T1加权像上测量了肝脏在反相和同相序列中的信号强度（SI）。中位同相SI显著低于反相SI（Wilcoxon-Mann-Whitney检验，P <0.012;补充数字内容1，图1，http：//links. lww。com/MPG/A727），同相/反相SI比（SIR）为0.78。其次，我们计算了T2加权半傅立叶单次激发快速自旋回波图像中胎儿肝脏（fL）与胎儿髂腰肌（fM）的SIR。fL/fM比值为0.70，显著低于10例无肝损伤胎儿的fL/fM比值（Wilcoxon符号秩检验，P <0.05）。002;补充数字内容2，表1，http：//links. lww。com/MPG/A728）。2个肝外器官（胎儿胰腺[fP]和胎儿脾脏[fS]）的SIR，即fP/fM和fS/fM，分别为1.36和1.74，表明铁沉积仅限于肝脏。婴儿出生时健康，但实验室数据异常（补充数字内容1，图2，http：//links. lww。com/MPG/A727）。这些数据在9天后变得正常，没有任何特定的治疗。在1年期间，肝脏中的低MRI同相SI也逐渐改善。这些非侵入性方法可以预测子宫内NH-GALD肝损伤的程度。然而，这项研究的一个重要局限性是，只有一个病人被招募，需要进一步的研究来验证这种胎儿MRI成像的有用性。
To the Editor: Neonatal hemochromatosis caused by gesta-tional alloimmune liver disease (NH-GALD) is improved by maternal intravenous immunoglobulin infusions (IVIG)(1). We, however, have no clinical markers for in utero monitoring of fetal hepatic injury caused by NH-GALD. A 36-year-old Japanese woman, whose newborn had died 17 hours after birth as a result of clinically and histologically proven NH-GALD 2 years ago, consulted our hospital. During her next pregnancy, she received IVIG from 14 weeks based on a previous protocol (2). At 38 weeks, we used 2 methods of fetal magnetic resonance imaging (MRI) to evaluate the fetal liver condition (3, 4). First, we measured the signal intensity (SI) of the liver in opposedphase and in-phase sequences in T1-weighted images. The median in-phase SI was significantly lower than the opposed-phase SI (Wilcoxon-Mann-Whitney test, P¼ 0.012; Supplemental Digital Content 1, Fig. 1, http://links. lww. com/MPG/A727), and the inphase/opposed-phase SI ratio (SIR) was 0.78. Second, we calculated the SIR of the fetal liver (fL) to the fetal iliopsoas muscle (fM) in T2-weighted half-Fourier single-shot turbo spin-echo images. The fL/fM ratio was 0.70, significantly lower than those in 10 fetuses without liver injury (Wilcoxon signed-rank test, P ¼0. 002; Supplemental Digital Content 2, Table 1, http://links. lww. com/MPG/A728). The SIRs for 2 extrahepatic organs (fetal pancreas [fP] and fetal spleen [fS]), that is, fP/fM and fS/fM, were 1.36 and 1.74, suggesting that iron deposition was limited to the liver. The baby was born healthy, but with abnormal laboratory data (Supplemental Digital Content 1, Fig. 2, http://links. lww. com/MPG/A727). Those data became normal, without any specific treatment, after 9 days. Low MRI in-phase SI in the liver also gradually improved during 1 year. These noninvasive methods may predict the degree of NH-GALD liver injury in utero. However, a significant limitation of this study is that only a single patient was enrolled, and further studies are needed to validate the usefulness of such fetal MRI imaging.