{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T23:18:29Z","timestamp":1786663109338,"version":"build-2736575974"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T00:00:00Z","timestamp":1733875200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T00:00:00Z","timestamp":1733875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Study design<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Fetuses receiving transfusions had significantly larger volumes of both liver (<jats:italic>p<\/jats:italic>\u2009=\u20090.003) and spleen (<jats:italic>p<\/jats:italic>\u2009=\u20090.029). T1 SI inversely correlated with the number of IUTs (Pearson\u2019s <jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.43, <jats:italic>p<\/jats:italic>\u2009=\u20090.099). This effect regressed over time (<jats:italic>r<\/jats:italic>\u2009=\u20090.69, <jats:italic>p<\/jats:italic>\u2009=\u20090.057). T2 SI did not correlate significantly with transfusion frequency but showed a strong positive correlation with the number of days between IUT and MRI (<jats:italic>r<\/jats:italic>\u2009=\u20090.91, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). For splenic SI measures, similar effects were observed regarding T1 SI reduction per received transfusion (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.36, <jats:italic>p<\/jats:italic>\u2009=\u20090.167) and recovery of T2 SI after IUT (<jats:italic>r<\/jats:italic>\u2009=\u20090.88, <jats:italic>p<\/jats:italic>\u2009=\u20090.004).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key Points<\/jats:title>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Question<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>What fetal changes are found by MRI after life-saving intrauterine transfusion (IUT)?<\/jats:italic>\n            <\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Findings<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>Dose- and time-dependent reductions in signal intensity of the fetal liver and spleen, as well as hepatosplenomegaly, were found after intrauterine transfusion.<\/jats:italic>\n            <\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Clinical relevance<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>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\u2019 awareness of changes following IUT may improve report quality<\/jats:italic>.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00330-024-11228-y","type":"journal-article","created":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T22:21:18Z","timestamp":1733955678000},"page":"1605-1614","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intrauterine blood transfusion causes dose- and time-dependent signal alterations in the liver and the spleen on fetal magnetic resonance imaging"],"prefix":"10.1007","volume":"35","author":[{"given":"Michael","family":"Schwarz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3599-1436","authenticated-orcid":false,"given":"Victor Ulrich","family":"Schmidbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Malik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus Michael","family":"Nowak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patric","family":"Kienast","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Watzenboeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene","family":"Stuempflen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Schwarz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Kittinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter","family":"Bettelheim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Haberl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Binder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Kiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Reiberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Prayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Kasprian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,12,11]]},"reference":[{"key":"11228_CR1","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1097\/AOG.0b013e31817d453c","volume":"112","author":"KJ Moise Jr","year":"2008","unstructured":"Moise KJ Jr (2008) Management of rhesus alloimmunization in pregnancy. 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C.S. received travel support from Gilead, Abbvie, and Gebro; speaking honoraria from Abbvie and Gilead; and payments for consulting from Gilead. J.B. received speaking honoraria from Roche Diagnostics and honoraria from Biomarin (advisory board for Achondroplasia). T.R. received grant support from Abbvie, Boehringer Ingelheim, Gilead, Intercept\/Advanz Pharma, MSD, Myr Pharmaceuticals, Philips Healthcare, Pliant, Siemens and W. L. Gore & Associates; speaking honoraria from Abbvie, Gilead, Intercept\/Advanz Pharma, Roche, MSD, W. L. Gore & Associates; consulting\/advisory board fee from Abbvie, Astra Zeneca, Bayer, Boehringer Ingelheim, Gilead, Intercept\/Advanz Pharma, MSD, Resolution Therapeutics, Siemens; and travel support from Abbvie, Boehringer Ingelheim, Dr. Falk Pharma, Gilead and Roche. M.W. is a member of the Scientific Editorial Board of European Radiology (section: Chest). They did not participate in the selection or review processes for this article. The remaining authors declare no potential conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No overlap.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}