Jelin Angie C, Norton Mary E, Bartha Agnes I, Fick Andrea L, Glenn Orit A
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, School of Medicine, San Francisco, CA, USA.
Am J Obstet Gynecol. 2008 Oct;199(4):398.e1-5. doi: 10.1016/j.ajog.2008.06.062.
This study was undertaken to evaluate intracranial magnetic resonance imaging abnormalities in the surviving fetus after a cotwin demise.
This is a retrospective observational study evaluating the intracranial findings of surviving twins after demise of a monochorionic cotwin. A total of 47 cases of cotwin demise were identified from an magnetic resonance imaging database consisting of all fetal magnetic resonance imagings performed at the University of California San Francisco. Twenty-one of these cases were monochorionic twins who had not undergone an intervention (fetal radiofrequency ablation and placental laser ablation) and these comprised the study group. The magnetic resonance imagings were reviewed by a pediatric neuroradiologist who was blinded to the ultrasound and clinical findings.
The mean gestational age at the time of cotwin demise was 19(6/7) weeks (range 12(4/7) weeks-26(5/7) weeks) with an average interval of 4(3/7) weeks between the time of cotwin demise and fetal magnetic resonance imaging (range 0-12(1/7) weeks). Nine cases (41%) were associated with diagnosed twin-twin transfusion syndrome. Abnormal findings, including polymicrogyria, germinolytic cysts, intracranial hemorrhage, ventriculomegaly, and delayed sulcation were identified by fetal magnetic resonance imaging in 7 (33%) cases, the majority of which had a normal ultrasound.
Prenatal magnetic resonance imaging is a valuable tool in evaluating the fetal brain after a cotwin demise.
本研究旨在评估单绒毛膜双胎之一死亡后存活胎儿的颅内磁共振成像异常情况。
这是一项回顾性观察研究，评估单绒毛膜双胎之一死亡后存活双胎的颅内检查结果。从加利福尼亚大学旧金山分校进行的所有胎儿磁共振成像组成的磁共振成像数据库中，共识别出47例双胎之一死亡的病例。其中21例为未接受干预（胎儿射频消融和胎盘激光消融）的单绒毛膜双胎，这些构成了研究组。磁共振成像由一位对超声和临床检查结果不知情的儿科神经放射科医生进行评估。
双胎之一死亡时的平均孕周为19（6/7）周（范围为12（4/7）周 - 26（5/7）周），双胎之一死亡至胎儿磁共振成像的平均间隔时间为4（3/7）周（范围为0 - 12（1/7）周）。9例（41%）与诊断为双胎输血综合征有关。胎儿磁共振成像在7例（33%）中发现了包括多小脑回、生发层囊肿、颅内出血、脑室扩大和脑沟延迟等异常表现，其中大多数超声检查正常。
产前磁共振成像在评估双胎之一死亡后的胎儿脑部情况时是一种有价值的工具。
