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Published on: September 5, 2011
Brain-injured Survivors of Monochorionic Twin Pregnancies Complicated by Single Intrauterine Death: MR Findings in a
Giorgio Conte1, Andrea Righini1, Paul D Griffiths1
1From the Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20142, Milan, Italy (G.C., F.T.); Division of Paediatric Radiology and Neuroradiology, Ospedale dei Bambini V. Buzzi, Milan, Italy (G.C., A.R., C.P., C.D.); Academic Unit of Radiology, University of Sheffield, Sheffield, England (P.D.G.); Fetal Therapy Unit Umberto Nicolini, Department of Woman Mother and Neonate, Ospedale dei Bambini V. Buzzi, Milan, Italy (M.R., M.L.); Centre of Women's and Newborn's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, England (F.L.M.); Neuroradiology Unit, Spedali Civili, Brescia, Italy (L.P., C.A.); Department of Obstetrics and Gynecology, Università degli Studi di Brescia, Brescia, Italy (F.P., A.F.); Division of Prenatal Diagnosis, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy (N.P.); Department of Radiology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, England (M.S.I., N.S.); Department of Fetal Medicine, University of Birmingham, Birmingham, England (M.K.); Pediatric Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy (M.S., A.R.); and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy (F.T.).
Purpose To describe and classify the range of brain injuries present at prenatal, in-utero magnetic resonance (MR) imaging in co-twin survivors of monochorionic (MC) twin pregnancies complicated by single intrauterine death (SIUD). Materials and Methods This retrospective, observational study from six tertiary fetal medicine centers that perform tertiary-level prenatal in-utero MR studies reviewed cases in which prenatal in-utero MR imaging had shown a brain injury in a surviving co-twin of a twin pregnancy with a MC component complicated by SIUD. Results Forty-two surviving MC twins were described. The primary distinction of brain abnormalities was into nonfocal and focal lesions. The nonfocal lesions included periventricular leukomalacia (group 1; two fetuses), generalized encephalomalacia (group 2; nine fetuses), posterior encephalomalacia (group 3; seven fetuses), and bilateral parasagittal and perisylvian injury (group 4; three fetuses). The focal lesions included nonhemorrhagic lesions (group 5; 14 fetuses) and hemorrhagic lesions (group 6; seven fetuses). Focal brain lesions were more likely to be found in the surviving MC pregnancies complicated by twin-twin transfusion syndrome (TTTS) (odds ratio, 2.4; 95% confidence interval: 1.3, 18.5; P = .01) and in fetuses that underwent an obstetric intervention (odds ratio, 2.8; 95% confidence interval: 1.8, 23.6; P = .006). Conclusion Brain injury of the surviving co-twin after SIUD in MC pregnancies is usually of ischemic origin and spares the brainstem and cerebellum. Focal brain lesions are more frequent in pregnancies complicated by TTTS or in those where an intervention has been performed.
Purpose To describe and classify the range of brain injuries present at prenatal, in-utero magnetic resonance (MR) imaging in co-twin survivors of monochorionic (MC) twin pregnancies complicated by single intrauterine death (SIUD). Materials and Methods This retrospective, observational study from six tertiary fetal medicine centers that perform tertiary-level prenatal in-utero MR studies reviewed cases in which prenatal in-utero MR imaging had shown a brain injury in a surviving co-twin of a twin pregnancy with a MC component complicated by SIUD. Results Forty-two surviving MC twins were described. The primary distinction of brain abnormalities was into nonfocal and focal lesions. The nonfocal lesions included periventricular leukomalacia (group 1; two fetuses), generalized encephalomalacia (group 2; nine fetuses), posterior encephalomalacia (group 3; seven fetuses), and bilateral parasagittal and perisylvian injury (group 4; three fetuses). The focal lesions included nonhemorrhagic lesions (group 5; 14 fetuses) and hemorrhagic lesions (group 6; seven fetuses). Focal brain lesions were more likely to be found in the surviving MC pregnancies complicated by twin-twin transfusion syndrome (TTTS) (odds ratio, 2.4; 95% confidence interval: 1.3, 18.5; P = .01) and in fetuses that underwent an obstetric intervention (odds ratio, 2.8; 95% confidence interval: 1.8, 23.6; P = .006). Conclusion Brain injury of the surviving co-twin after SIUD in MC pregnancies is usually of ischemic origin and spares the brainstem and cerebellum. Focal brain lesions are more frequent in pregnancies complicated by TTTS or in those where an intervention has been performed.
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