Fetal liver iron overload: The role of MR imaging

Objective: To assess the potential role of MR imaging in the diagnosis of fetal liver iron overload. Methods: We reviewed seven cases of abnormal liver signal in fetuses referred to MR imaging in a context of suspected congenital infection (n∈=∈2), digestive tract anomalies (n∈=∈3) and hydrops fetalis (n∈=∈2). The average GA of the fetuses was 31 weeks. The antenatal diagnoses were compared with histological data (n∈=∈6) and postnatal work-up (n∈=∈1). Results: Magnetic resonance imaging demonstrated unexpected abnormal fetal liver signal suggestive of iron overload in all cases. The iron overload was confirmed on postnatal biopsy (n∈=∈2) and fetopathology (n∈=∈4). The final diagnosis was hepatic hemosiderosis (haemolytic anaemia (n∈=∈2) and syndromal anomalies (n∈=∈2)) and congenital haemochromatosis (n∈=∈3). In all cases, the liver appeared normal on US. Conclusions: Magnetic resonance is the only imaging technique able to demonstrate liver iron overload in utero. Yet, the study outlines the fundamental role of MR imaging in cases of congenital haemochromatosis. The antenatal diagnosis of such a condition may prompt ante-(in the case of recurrence) or neonatal treatment, which might improve the prognosis. © 2010 European Society of Radiology.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Fetomaternal alloimmunity as a cause of liver disease

Fetomaternal alloimmune disease has traditionally been associated with haematological disease such as fetomaternal alloimmune thrombocytopaenia and Rh haemolytic anaemia, but is now known to also be organ specific. Alloimmune membranous glomerulonephritis (AMG) is one of the most well understood organ-specific alloimmune diseases. Neonatal haemochromatosis (NH) is a rare condition characterised by early liver failure in infants, with evidence suggesting that it is also alloimmune. Both AMG and NH appear to involve the passive transfer of alloantibodies to the fetus, which bind a specific alloantigen, fix complement and activate the terminal complement cascade. Although differences between AMG and NH are known, and evidence of the presence of antigen-specific alloantibodies in NH is still missing, we will use AMG as an example of fetomaternal organ specific alloimmune disease, and critically compare this to other emerging evidence that indicates that NH is also alloimmune. © 2011 Springer-Verlag