THE ROLE OF MAGNETIC RESONANCE IMAGING IN THE PERINATAL ASSESSMENT OF THE CONDITION FETAL CNS WITH HEMOLYTIC DISEASE, WHO RECEIVED TREATMENT BY INTRAUTERINE INTRAVASCULAR BLOOD TRANSFUSION

Objective: to determine the role of magnetic resonance imaging (MRI) in the pathomorphological evaluation of focal changes in the central nervous system (CNS) of fetuses with hemolytic disease before and after treatment, by intrauterine intravascular blood transfusion, and to compare the MRI data of fetuses with ultrasound neurosonography (NSH) newborns. The study included 45 pregnant women and their 45 newborns. Patients are divided into 2 groups. The main group: 30 pregnant women (mean gestation period 32,1 weeks) with hemolytic disease of the fetus who underwent intrauterine intravascular blood transfusion and their 30 newborns with hemolytic disease of the newborn. In this group, comparative MRI examinations of the central nervous system were performed using a protocol including fast MP sequences based on T1 and T2-weighted images, as well as the DWI pulse sequence, both before treatment (intrauterine intravascular blood transfusion of the fetus), and after treatment (regardless of the multiplicity of intrauterine intravascular transfusion — before delivery). The comparison group comprised 15 pregnant women (mean gestation period of 38,6 weeks) with no signs of hemolytic disease, examined by MRI for other indications (concomitant pathology of pregnancy) and their 15 newborns, comparable in gestational age to the main group. The obstetric anamnesis, the MRI data of the central nervous system of fetuses before the treatment (the first intrauterine intravascular transfusion) and after the treatment (before the delivery) and the results of ultrasound for the first day of life were analyzed. When comparing the MRI data of changes in the central nervous system, in the main group (in fetuses with bladder) in relation to the comparison group before treatment (the first intrauterine, intravascular transfusion), a high incidence of focal changes in the brain substance in the main group was revealed. The use of MRIdiagnostics demonstrates a decrease in the risk of development of PCNC in ischemic type, in dynamics before and after treatment. Based on the MRI diagnostic data of the fetal CNS, it is possible to judge the prognosis of the outcomes of hemolytic disease of the fetus, in comparison with the neonatal neurosonography data for the first day.

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