Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat Gan, Israel.
Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
Eur Radiol. 2021 Sep;31(9):6676-6685. doi: 10.1007/s00330-021-07773-5. Epub 2021 Mar 16.
This study employed magnetic resonance imaging (MRI) to compare brain volumes of discordant twins and examined their neurodevelopment after birth by using a validated exam.
A prospective historical cohort study of discordant dichorionic diamniotic (DCDA) or monochorionic diamniotic (MCDA) twin fetuses, who undergone an MRI scan to evaluate growth restriction in the discordant twin (weight < 10 centile) during 6 years period, at a single tertiary center. Twenty-seven twin pairs were included in the volumetric study and 17 pairs were included in the neurodevelopmental outcome examination. The volumes of the supratentorial brain region, both hemispheres, eyes, and the cerebellum were measured by 3D MRI semi-automated volume measurements. Volumes were plotted on normal growth curves and discordance was compared between weight at birth and brain structure volumes. Neurodevelopmental outcome was evaluated using the VABS-II questionnaire at a mean age of 4.9 years.
The volume of major brain structures was significantly larger in the appropriate-for-gestational-age twins (AGA) compared to the small-for-gestational-age (SGA) co-twins (p < 0.001). The birth weight discordance was 32.3% (24.9-48.6) and was significantly greater (p < 0.001) than the discordance of the prenatal supratentorial brain (13.6% [5.6-18]), cerebellum volume (21.7% [9.5-30.8]). Further neurodevelopmental outcome evaluation found no significant difference between the AGA twin and the SGA twin.
In discordant twins, the smaller twin showed a "brain-preserving effect," which in our study was not associated with a worse neurodevelopmental outcome. The use of MRI in such cases may aid in decision-making and parental consultation.
• Weight discordance at birth was significantly greater compared to intrauterine brain volume discordance measured by 3D MRI. • Small-for-gestational-age (SGA) fetuses preserve brain development. • In highly discordant twins, there was no long-term difference in neurodevelopmental outcome at a mean age of 4.9 years.
本研究采用磁共振成像（MRI）比较了不一致双胞胎的脑容量，并通过使用经过验证的检查来研究他们出生后的神经发育情况。
这是一项在单中心进行的前瞻性历史队列研究，纳入了在 6 年期间因生长受限而接受 MRI 扫描评估不一致双胞胎（体重＜第 10 百分位数）的不一致双绒毛膜双羊膜囊（DCDA）或单绒毛膜双羊膜囊（MCDA）双胎胎儿。27 对双胞胎被纳入体积研究，17 对被纳入神经发育结局检查。通过 3D MRI 半自动体积测量法测量了大脑前区、两个半球、眼睛和小脑的体积。将体积绘制在正常生长曲线上，并比较了出生体重与脑结构体积之间的差异。使用 VB-AI 问卷在平均年龄为 4.9 岁时评估神经发育结局。
在适合胎龄（AGA）双胞胎中，主要脑结构的体积明显大于小于胎龄（SGA）的同卵双胞胎（p＜0.001）。出生体重差异为 32.3%（24.9-48.6），明显大于（p＜0.001）产前大脑前区（13.6%[5.6-18%]）和小脑体积（21.7%[9.5-30.8%]）的差异。进一步的神经发育结局评估发现，AGA 双胞胎和 SGA 双胞胎之间没有显著差异。
在不一致的双胞胎中，较小的双胞胎表现出“脑保护效应”，但在我们的研究中，这与神经发育结局较差无关。在这种情况下使用 MRI 可能有助于决策和家长咨询。
出生时的体重差异明显大于 3D MRI 测量的宫内脑容量差异。
小于胎龄（SGA）的胎儿可以保护脑发育。
在高度不一致的双胞胎中，在平均年龄为 4.9 岁时，神经发育结局没有长期差异。
