Third Trimester Structural and Diffusion Brain Imaging after Single Intrauterine Fetal Death in Monochorionic Twins:...

Area of Science:

• Perinatology
• Fetal Medicine
• Neuroimaging

Background:

• Single intrauterine fetal death (IUFD) poses risks for surviving twins.
• Antenatal brain lesions are a concern in surviving fetuses.
• Evaluating fetal brain development after IUFD is crucial.

Purpose of the Study:

• To assess the prevalence of structural brain lesions in surviving twins.
• To evaluate fetal brain biometry and diffusivity using third-trimester MRI after single IUFD.
• To compare findings with control groups.

Main Methods:

• Retrospective cohort study comparing 29 monochorionic twins with single IUFD to singleton and uncomplicated twin controls.
• All fetuses underwent third-trimester fetal brain MRI.
• Analysis of structural brain lesions, cerebral biometry, and water diffusion (ADC values).

Main Results:

• One of 29 surviving twins had brain lesions consistent with prior ischemic injury, undetected by ultrasound.
• Supratentorial biometry was smaller than in singletons but similar to uncomplicated twins.
• No significant differences in apparent diffusion coefficient (ADC) values were observed between groups.

Conclusions:

• Normal diffusivity suggests preserved parenchymal microstructure in surviving twins.
• The low rate of structural injury does not support routine fetal brain MRI after single IUFD.
• Further prospective studies are needed to establish optimal surveillance protocols.