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.