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Middle cerebral artery velocity time integral as a predictor of fetal anemia using fetal hemoglobin Bart's disease as
Objective:
To assess the diagnostic performance of middle cerebral artery (MCA) velocity time integral (VTI) in predicting fetal hemoglobin (Hb) Bart's disease.
Methods:
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.
Results:
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).
Conclusion:
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.
