Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
Department of Imaging and Pathology, Biomedical Sciences, KU Leuven, Leuven, Belgium.
Eur Radiol. 2021 Jun;31(6):4097-4103. doi: 10.1007/s00330-020-07452-x. Epub 2020 Nov 19.
Due to the increased risk of antenatal brain lesions, we offer a third-trimester magnetic resonance imaging (MRI) scan to all patients who underwent an in utero intervention for twin-twin transfusion syndrome (TTTS). However, the usefulness of such a policy has not been demonstrated yet. Therefore, we determined the prevalence of antenatal brain lesions detected on third-trimester MRI and the proportion of lesions detected exclusively on MRI.
We conducted a retrospective cohort study of monochorionic diamniotic twin pregnancies complicated by TTTS that underwent laser coagulation of the vascular anastomoses or fetal reduction by umbilical cord occlusion between 2010 and 2017. We reviewed the third-trimester MRI findings and compared those with the prenatal ultrasonography.
Of the 141 patients treated with laser coagulation and 17 managed by cord occlusion, 112/141 (79%) and 15/17 (88%) patients reached 28 weeks. Of those, 69/112 (62%) and 11/15 (73%) underwent an MRI between 28 and 32 weeks. After laser coagulation, MRI detected an antenatal brain lesion in 6 of 69 pregnancies (9%) or in 6 of 125 fetuses (5%). In 4 cases (67%), the lesion was detected only on MRI. In the 11 patients treated with cord occlusion, no brain lesions were diagnosed.
The prevalence of brain lesions detected by third-trimester MRI is higher compared to prenatal ultrasonography alone, making MRI a useful adjunct to detect antenatal brain lesions in twin pregnancies after in utero treatment for TTTS.
• In utero interventions for twin-to-twin transfusion syndrome (TTTS) do not prevent the occurrence of antenatal brain lesions. • Fetal magnetic resonance imaging (MRI) has high accuracy in detecting anomalies of cortical development and can be a useful adjunct to ultrasonography in diagnosing certain brain abnormalities. • After laser coagulation of the anastomoses for TTTS, third-trimester MRI diagnosed a brain lesion that was not detected earlier on ultrasound scan in 6% of pregnancies.
由于产前脑损伤的风险增加，我们为所有接受双胎输血综合征（TTTS）宫内干预的患者提供了孕晚期磁共振成像（MRI）检查。然而，这种策略的有效性尚未得到证实。因此，我们确定了孕晚期 MRI 检查中发现的产前脑损伤的发生率以及仅在 MRI 检查中发现的损伤比例。
我们对 2010 年至 2017 年间接受血管吻合激光凝固或脐带结扎胎儿减少治疗的单绒毛膜双羊膜性 TTTS 双胎妊娠进行了回顾性队列研究。我们回顾了孕晚期 MRI 检查结果，并与产前超声检查结果进行了比较。
在接受激光凝固治疗的 141 例患者和接受脐带结扎治疗的 17 例患者中，112/141（79%）和 15/17（88%）例患者达到 28 周。其中，69/112（62%）和 11/15（73%）例患者在 28 至 32 周之间进行了 MRI 检查。在激光凝固治疗后，MRI 在 69 例妊娠中的 6 例（9%）或 125 例胎儿中的 6 例（5%）中发现了产前脑损伤。在 4 例（67%）中，病变仅在 MRI 上发现。在接受脐带结扎治疗的 11 例患者中，未诊断出脑损伤。
与单独产前超声检查相比，孕晚期 MRI 检查发现脑损伤的发生率更高，因此 MRI 是一种有用的辅助手段，可用于检测 TTTS 胎儿宫内治疗后双胎妊娠的产前脑损伤。
双胎输血综合征（TTTS）的宫内干预并不能预防产前脑损伤的发生。
胎儿磁共振成像（MRI）在检测皮质发育异常方面具有较高的准确性，可作为超声检查诊断某些脑异常的有用辅助手段。
在 TTTS 吻合处激光凝固后，MRI 在 6%的妊娠中诊断出了超声检查未更早发现的脑损伤。
