Parapob N, Jatavan P, Luewan S, Tongsong T
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Ultrasound Obstet Gynecol. 2025 May;65(5):597-603. doi: 10.1002/uog.29213. Epub 2025 Mar 27.
To assess the diagnostic performance of middle cerebral artery (MCA) velocity time integral (VTI) in predicting fetal hemoglobin (Hb) Bart's disease.
This was a secondary analysis of data collected prospectively from pregnant women at risk for fetal Hb Bart's disease assessed at 17-22 weeks' gestation, receiving care at the Maternal-Fetal Medicine Unit, Chiang Mai Hospital, Thailand, between January 2008 and December 2023. Each fetus underwent prenatal measurement of MCA peak systolic velocity (PSV) and MCA-VTI. Final diagnosis of Hb Bart's disease was confirmed by Hb typing of cord blood, obtained by cordocentesis. MCA-PSV and MCA-VTI were evaluated both as absolute values and multiples of median (MoM) normalized for gestational age. Diagnostic performance of MCA-PSV and MCA-VTI for predicting fetal Hb Bart's disease was evaluated and compared using area under the receiver-operating-characteristics curve (AUC), sensitivity, specificity and positive and negative predictive values.
A total of 485 fetuses at risk for Hb Bart's disease (109 affected, 376 unaffected) met the inclusion criteria. Absolute MCA-VTI values were significantly higher in affected compared with unaffected fetuses (7.9 ± 1.8 vs 5.4 ± 1.3; P < 0.001) as were MoM values (1.5 ± 0.3 vs 1.0 ± 0.2; P < 0.001). The diagnostic performance of MCA-VTI was superior to that of MCA-PSV for detecting fetal anemia due to Hb Bart's disease, with AUCs of 0.877 (95% CI, 0.836-0.917) and 0.898 (95% CI, 0.857-0.938) for absolute MCA-VTI values (in cm) and MCA-VTI MoM, respectively, compared with 0.842 (95% CI, 0.795-0.889) and 0.854 (95% CI, 0.809-0.899) for absolute MCA-PSV values (in cm/s) and MCA-PSV MoM, respectively (P < 0.001).
MCA-VTI is more accurate compared with MCA-PSV for predicting fetal Hb Bart's disease, which indirectly reflects anemia. This suggests that MCA-VTI could serve as an alternative or adjunct to MCA-PSV for detecting fetal anemia, particularly in cases of Hb Bart's disease and potentially for other etiologies. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.
评估大脑中动脉（MCA）血流速度时间积分（VTI）在预测胎儿血红蛋白Bart氏病中的诊断效能。
这是一项对前瞻性收集的数据进行的二次分析，这些数据来自于2008年1月至2023年12月期间在泰国清迈医院母胎医学科接受治疗的、妊娠17 - 22周时被评估为有胎儿血红蛋白Bart氏病风险的孕妇。每个胎儿均接受了MCA收缩期峰值流速（PSV）和MCA-VTI的产前测量。通过脐静脉穿刺获取脐血进行血红蛋白分型，从而确诊血红蛋白Bart氏病。MCA-PSV和MCA-VTI均以绝对值以及根据孕周标准化后的中位数倍数（MoM）进行评估。使用受试者操作特征曲线下面积（AUC）、敏感度、特异度以及阳性和阴性预测值来评估和比较MCA-PSV和MCA-VTI对预测胎儿血红蛋白Bart氏病的诊断效能。
共有485例有血红蛋白Bart氏病风险的胎儿（109例患病，376例未患病）符合纳入标准。患病胎儿的MCA-VTI绝对值显著高于未患病胎儿（7.9±1.8 vs 5.4±1.3；P<0.001），MoM值也是如此（1.5±0.3 vs 1.0±0.2；P<0.001）。在检测由血红蛋白Bart氏病导致的胎儿贫血方面，MCA-VTI的诊断效能优于MCA-PSV，MCA-VTI绝对值（单位：cm）和MCA-VTI MoM的AUC分别为0.877（95%CI，0.836 - 0.917）和0.898（95%CI，0.857 - 0.938），而MCA-PSV绝对值（单位：cm/s）和MCA-PSV MoM的AUC分别为0.842（95%CI，0.795 - 0.889）和0.854（95%CI，0.809 - 0.899）（P<0.001）。
与MCA-PSV相比，MCA-VTI在预测胎儿血红蛋白Bart氏病方面更准确，该疾病间接反映贫血情况。这表明MCA-VTI可作为MCA-PSV的替代方法或辅助手段用于检测胎儿贫血，尤其是在血红蛋白Bart氏病的病例中，可能也适用于其他病因导致的贫血。©2025国际妇产科超声学会
