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- Title
Magnetic resonance imaging of intracranial anomalies in pregnancies complicated by twin anemia-polycythemia sequence.
- Authors
Tricca, Stefano; Parazzini, Cecilia; Doneda, Chiara; Arrigoni, Filippo; Tortora, Mario; Lanna, Mariano; Casati, Daniela; Faiola, Stefano; Righini, Andrea; Izzo, Giana
- Abstract
Purpose: To describe fetal brain Magnetic Resonance Imaging (MRI) findings in a large series of monochorionic (MC) pregnancies complicated by Twin Anemia-Polycythemia Sequence (TAPS) prenatally diagnosed, so to characterize the potential intracranial complications associated with this condition, their frequency and potential treatment options. Methods: This is a retrospective study of MC twin pregnancies complicated by TAPS and undergone fetal MRI in a single institution from 2006 to 2023. MRI control was performed and post-natal ultrasound (US) or MRI were available. Results: 1250 MC pregnancies were evaluated in our institution. 50 pregnancies (4%) were diagnosed with TAPS, 29 underwent a fetal brain MRI. 13/29 pregnancies (44.8%) demonstrated brain findings at MRI in at least a twin. Neuroradiological findings were detected in 14/57 twins (24.6%). We detected four main categories of findings: hemorrhagic lesions, T2-weighted white-matter hyperintensities (WMH), brain edema-swelling and venous congestion. Nineteen findings were present in the anemic and three in the polycythemic twins, with a statistically significant ratio between the two groups (p-value = 0.01). Intrauterine MRI follow-up demonstrated the sequalae of hemorrhagic lesions. A complete regression of brain swelling, veins prominence and T2-WMHs was demonstrated after treatment. Postnatal imaging confirmed prenatal features. Conclusions: Our work demonstrates that TAPS-related MRI anomalies consisted in edematous/hemorrhagic lesions that occur mostly in anemic rather than in polycythemic twins. Fetoscopic laser surgery could have a potential decongestant role. Therefore, prenatal MRI may help in counselling and management in TAPS pregnancies, especially for the planning of therapy and the monitoring of its efficacy.
- Subjects
BRAIN abnormalities; ANEMIA diagnosis; POLYCYTHEMIA; MULTIPLE pregnancy; PUERPERIUM; EDEMA; MAGNETIC resonance imaging; PRENATAL diagnosis; RETROSPECTIVE studies; ULTRASONIC imaging; DESCRIPTIVE statistics; BRAIN diseases; FETAL abnormalities; WHITE matter (Nerve tissue); FETAL development; PREGNANCY complications; FETUS
- Publication
Neuroradiology, 2024, Vol 66, Issue 7, p1213
- ISSN
0028-3940
- Publication type
Article
- DOI
10.1007/s00234-024-03373-4