Feasibility and reproducibility of diffusion‐weighted magnetic resonance imaging of the fetal brain in twin–twin transfusion syndrome

Neto, Orlando Gomes dos Santos; Marins, Marcos; Botelho, Rafael Davi; Nivoloni, Rafaela C.; Saura, Glauco E.; Arias, Amábile Vessoni; Barini, Ricardo; Peralta, Cleisson Fábio Andrioli

doi:10.1002/pd.4449

Cited by 6 publications

(2 citation statements)

References 34 publications

(85 reference statements)

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“…In previous studies by our group, we could not find a relationship between prenatal fetal ultrasound parameters and the results of magnetic resonance imaging (MRI) performed before and after LAPV in cases of severe TOPS with infant neurological outcomes evaluated with the Bayley's scale. [34][35][36] It could be speculated that some Doppler findings in cases of TOPS and/or TAPS could be associated with a certain degree of brain hypoxia, however, this needs to be further evaluated…”

Section: Interpretation In the Context Of What Is Known On The Topicmentioning

confidence: 99%

Predictors of fetal death, neonatal survival and neurological outcomes in severe twin‐twin transfusion syndrome treated by laser ablation of placental vessels

Andrioli Peralta,

Jorge Rodrigues da Costa,

Peneluppi Horak

et al. 2024

Prenatal Diagnosis

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ObjectivesTo identify predictors of outcomes in severe twin oligo‐polyhydramnios sequence (TOPS) with or without twin anemia‐polycythemia sequence (TAPS) and/or selective fetal growth restriction (SFGR) treated by laser ablation of placental vessels (LAPV).MethodsAnalysis of cases treated from 2011 to 2022. Variables evaluated Prenatal predictors: stages of TOPS, presence of TAPS and/or SFGR; pre‐LAPV fetal ultrasound parameters; peri‐LAPV variables. Perinatal predictors: GA at birth; birthweight; Apgar scores; transfontanellar ultrasonography (TFUS). Outcome variables: fetal death, neonatal survival, infant's neurodevelopment. Binary logistic regression analyses were performed to detect predictors of outcomes.Results265 cases were included. Predictors of post‐LAPV donor fetus' death were delta EFW (p:0.045) and absent/reverse end‐diastolic flow in the umbilical artery (AREDF‐UA) (p < 0.001). The predictor of post‐LAPV recipient fetus' death was hydrops (p:0.009). Predictors of neonatal survival were GA at birth and Apgar scores. Predictors of infant's neurodevelopment were TFUS and pre‐LAPV middle cerebral artery Doppler (MCAD) for the donor twin; and pre‐LAPV ductus venosus' flow and MCAD for the recipient twin.ConclusionsPrediction of fetal death, neonatal survival and infant's neurodevelopment is possible in cases of TOPS associated or not with SFGR and/or TAPS that were treated by LAPV.

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Section: Interpretation In the Context Of What Is Known On The Topicmentioning

confidence: 99%

Predictors of fetal death, neonatal survival and neurological outcomes in severe twin‐twin transfusion syndrome treated by laser ablation of placental vessels

Andrioli Peralta,

Jorge Rodrigues da Costa,

Peneluppi Horak

et al. 2024

Prenatal Diagnosis

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“…However, acute ischemic white‐matter injury is usually not detected with this sequence. An alternative method to assess acute ischemia after sIUD is diffusion‐weighted imaging (DWI), which evaluates the microscopic diffusion of water 7–9 . DWI‐MRI reflects acute brain ischemia well 10,11 , allowing for a more rapid assessment compared with T2‐weighted MRI, which, like ultrasound, only shows volume loss at least 2 weeks after the acute event 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Early imaging predictors of fetal cerebral ischemic injury in monochorionic twin pregnancy complicated by spontaneous single intrauterine death

Shinar

Harris

Mieghem

et al. 2022

Ultrasound in Obstet & Gyne

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Objective Monochorionic twin pregnancies are at increased risk of single intrauterine death (sIUD) and subsequent brain injury in the surviving twin owing to shared placentation. We assessed the association between middle cerebral artery peak systolic velocity (MCA‐PSV) and cerebral injury on magnetic resonance imaging (MRI) and examined the association between cerebral findings on diffusion‐weighted imaging (DWI) and those on T2‐weighted imaging following spontaneous sIUD. Methods This was a retrospective cohort study of monochorionic pregnancies complicated by spontaneous sIUD followed at a tertiary center between January 2008 and January 2020. Pregnancies with sIUD following laser treatment, those with selective feticide, double IUD occurring on the same day or sIUD before 14 weeks' gestation were excluded, as were cases in which MCA‐PSV was not measured or DWI‐MRI was not performed. The ability of MCA‐PSV Doppler to predict subsequent cerebral injury on MRI was assessed, and DWI findings were analyzed and compared with those on susceptibility‐weighted imaging (SWI) and T2‐weighted MRI to determine its diagnostic accuracy. Results We assessed 64 monochorionic pregnancies complicated by spontaneous sIUD. Of these, 47 (73.4%) pregnancies underwent fetal brain MRI and met the inclusion criteria. Sixteen (34.0%) of these fetuses demonstrated cerebral injury on MRI. The median interval between the diagnosis of sIUD and MRI examination was 5 days. Fetuses with increased MCA‐PSV > 1.5 multiples of the median (MoM) following sIUD were significantly more likely to demonstrate cerebral injury on MRI than were those with normal MCA‐PSV (68.8% vs 38.7%; P = 0.05). The sensitivity and specificity of MCA‐PSV > 1.5 MoM for predicting cerebral injury on MRI were 68.8% (95% CI, 41.3–88.9%) and 61.3% (95% CI, 42.2–78.2%), respectively. Patterns of early cerebral injury on T2‐weighted and SWI‐MRI included acute or subacute tissue swelling (n = 6), parenchymal atrophy (n = 7), loss of cortical ribbon (n = 1) and hemorrhage (n = 8). Early MRI within approximately 2 weeks after the diagnosis of sIUD demonstrated abnormal DWI along with coexisting SWI and T2‐weighted sequelae in 56.3% (9/16) of cases. When DWI was normal and a second MRI examination was performed later (n = 7), there were no ischemic changes evident on T2‐weighted imaging. Conclusions Increased MCA‐PSV is associated with, but predicts poorly, cerebral injury after sIUD. Early MRI with DWI within approximately 2 weeks after the diagnosis of sIUD is valuable in identifying any cerebral injury. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

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Tools in Fetal Heart Procedures

Peralta

Pedra

2016

Fetal and Hybrid Procedures in Congenital Heart Diseases

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Feasibility and reproducibility of diffusion‐weighted magnetic resonance imaging of the fetal brain in twin–twin transfusion syndrome

Abstract: Our data demonstrate that DW-MRI evaluation of the fetal brain in TTTS is feasible and reproducible.

Cited by 6 publications

References 34 publications

Predictors of fetal death, neonatal survival and neurological outcomes in severe twin‐twin transfusion syndrome treated by laser ablation of placental vessels

Predictors of fetal death, neonatal survival and neurological outcomes in severe twin‐twin transfusion syndrome treated by laser ablation of placental vessels

Early imaging predictors of fetal cerebral ischemic injury in monochorionic twin pregnancy complicated by spontaneous single intrauterine death

Tools in Fetal Heart Procedures

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