Brain-injured survivors of monochorionic twin pregnancies complicated by single intrauterine death

MR findings in a multicenter study

Giorgio Conte, Andrea Righini, Paul D. Griffiths, Mariangela Rustico, Mariano Lanna, Fiona L. Mackie, Lorenzo Pinelli, Federico Prefumo, Nicola Persico, Mark S. Igra, Cecilia Parazzini, Chiara Doneda, Anna Fichera, Claudia Ambrosi, Mark Kilby, Mariasavina Severino, Fabio Triulzi, Andrea Rossi, Nicholas Skipper

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: To describe and classify the range of brain injuries present at prenatal, in-utero magnetic resonance (MR) imaging in cotwin survivors of monochorionic (MC) twin pregnancies complicated by single intrauterine death (SIUD). Materials and Methods: This retrospective, observational study from six tertiary fetal medicine centers that perform tertiary-level prenatal in-utero MR studies reviewed cases in which prenatal in-utero MR imaging had shown a brain injury in a surviving co-twin of a twin pregnancy with a MC component complicated by SIUD. Results: Forty-two surviving MC twins were described. The primary distinction of brain abnormalities was into nonfocal and focal lesions. The nonfocal lesions included periventricular leukomalacia (group 1; two fetuses), generalized encephalomalacia (group 2; nine fetuses), posterior encephalomalacia (group 3; seven fetuses), and bilateral parasagittal and perisylvian injury (group 4; three fetuses). The focal lesions included nonhemorrhagic lesions (group 5; 14 fetuses) and hemorrhagic lesions (group 6; seven fetuses). Focal brain lesions were more likely to be found in the surviving MC pregnancies complicated by twin-twin transfusion syndrome (TTTS) (odds ratio, 2.4; 95% confidence interval: 1.3, 18.5; P = .01) and in fetuses that underwent an obstetric intervention (odds ratio, 2.8; 95% confidence interval: 1.8, 23.6; P = .006). Conclusion: Brain injury of the surviving co-twin after SIUD in MC pregnancies is usually of ischemic origin and spares the brainstem and cerebellum. Focal brain lesions are more frequent in pregnancies complicated by TTTS or in those where an intervention has been performed.

Original languageEnglish
Pages (from-to)582-590
Number of pages9
JournalRadiology
Volume288
Issue number2
DOIs
Publication statusPublished - Aug 1 2018

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Twin Pregnancy
Multicenter Studies
Fetus
Magnetic Resonance Spectroscopy
Brain
Encephalomalacia
Fetofetal Transfusion
Brain Injuries
Pregnancy
Odds Ratio
Magnetic Resonance Imaging
Confidence Intervals
Periventricular Leukomalacia
Cerebellum
Brain Stem
Obstetrics
Observational Studies
Retrospective Studies
Medicine
Wounds and Injuries

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Brain-injured survivors of monochorionic twin pregnancies complicated by single intrauterine death : MR findings in a multicenter study. / Conte, Giorgio; Righini, Andrea; Griffiths, Paul D.; Rustico, Mariangela; Lanna, Mariano; Mackie, Fiona L.; Pinelli, Lorenzo; Prefumo, Federico; Persico, Nicola; Igra, Mark S.; Parazzini, Cecilia; Doneda, Chiara; Fichera, Anna; Ambrosi, Claudia; Kilby, Mark; Severino, Mariasavina; Triulzi, Fabio; Rossi, Andrea; Skipper, Nicholas.

In: Radiology, Vol. 288, No. 2, 01.08.2018, p. 582-590.

Research output: Contribution to journalArticle

Conte, G, Righini, A, Griffiths, PD, Rustico, M, Lanna, M, Mackie, FL, Pinelli, L, Prefumo, F, Persico, N, Igra, MS, Parazzini, C, Doneda, C, Fichera, A, Ambrosi, C, Kilby, M, Severino, M, Triulzi, F, Rossi, A & Skipper, N 2018, 'Brain-injured survivors of monochorionic twin pregnancies complicated by single intrauterine death: MR findings in a multicenter study', Radiology, vol. 288, no. 2, pp. 582-590. https://doi.org/10.1148/radiol.2018171267
Conte, Giorgio ; Righini, Andrea ; Griffiths, Paul D. ; Rustico, Mariangela ; Lanna, Mariano ; Mackie, Fiona L. ; Pinelli, Lorenzo ; Prefumo, Federico ; Persico, Nicola ; Igra, Mark S. ; Parazzini, Cecilia ; Doneda, Chiara ; Fichera, Anna ; Ambrosi, Claudia ; Kilby, Mark ; Severino, Mariasavina ; Triulzi, Fabio ; Rossi, Andrea ; Skipper, Nicholas. / Brain-injured survivors of monochorionic twin pregnancies complicated by single intrauterine death : MR findings in a multicenter study. In: Radiology. 2018 ; Vol. 288, No. 2. pp. 582-590.
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abstract = "Purpose: To describe and classify the range of brain injuries present at prenatal, in-utero magnetic resonance (MR) imaging in cotwin survivors of monochorionic (MC) twin pregnancies complicated by single intrauterine death (SIUD). Materials and Methods: This retrospective, observational study from six tertiary fetal medicine centers that perform tertiary-level prenatal in-utero MR studies reviewed cases in which prenatal in-utero MR imaging had shown a brain injury in a surviving co-twin of a twin pregnancy with a MC component complicated by SIUD. Results: Forty-two surviving MC twins were described. The primary distinction of brain abnormalities was into nonfocal and focal lesions. The nonfocal lesions included periventricular leukomalacia (group 1; two fetuses), generalized encephalomalacia (group 2; nine fetuses), posterior encephalomalacia (group 3; seven fetuses), and bilateral parasagittal and perisylvian injury (group 4; three fetuses). The focal lesions included nonhemorrhagic lesions (group 5; 14 fetuses) and hemorrhagic lesions (group 6; seven fetuses). Focal brain lesions were more likely to be found in the surviving MC pregnancies complicated by twin-twin transfusion syndrome (TTTS) (odds ratio, 2.4; 95{\%} confidence interval: 1.3, 18.5; P = .01) and in fetuses that underwent an obstetric intervention (odds ratio, 2.8; 95{\%} confidence interval: 1.8, 23.6; P = .006). Conclusion: Brain injury of the surviving co-twin after SIUD in MC pregnancies is usually of ischemic origin and spares the brainstem and cerebellum. Focal brain lesions are more frequent in pregnancies complicated by TTTS or in those where an intervention has been performed.",
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AU - Rustico, Mariangela

AU - Lanna, Mariano

AU - Mackie, Fiona L.

AU - Pinelli, Lorenzo

AU - Prefumo, Federico

AU - Persico, Nicola

AU - Igra, Mark S.

AU - Parazzini, Cecilia

AU - Doneda, Chiara

AU - Fichera, Anna

AU - Ambrosi, Claudia

AU - Kilby, Mark

AU - Severino, Mariasavina

AU - Triulzi, Fabio

AU - Rossi, Andrea

AU - Skipper, Nicholas

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N2 - Purpose: To describe and classify the range of brain injuries present at prenatal, in-utero magnetic resonance (MR) imaging in cotwin survivors of monochorionic (MC) twin pregnancies complicated by single intrauterine death (SIUD). Materials and Methods: This retrospective, observational study from six tertiary fetal medicine centers that perform tertiary-level prenatal in-utero MR studies reviewed cases in which prenatal in-utero MR imaging had shown a brain injury in a surviving co-twin of a twin pregnancy with a MC component complicated by SIUD. Results: Forty-two surviving MC twins were described. The primary distinction of brain abnormalities was into nonfocal and focal lesions. The nonfocal lesions included periventricular leukomalacia (group 1; two fetuses), generalized encephalomalacia (group 2; nine fetuses), posterior encephalomalacia (group 3; seven fetuses), and bilateral parasagittal and perisylvian injury (group 4; three fetuses). The focal lesions included nonhemorrhagic lesions (group 5; 14 fetuses) and hemorrhagic lesions (group 6; seven fetuses). Focal brain lesions were more likely to be found in the surviving MC pregnancies complicated by twin-twin transfusion syndrome (TTTS) (odds ratio, 2.4; 95% confidence interval: 1.3, 18.5; P = .01) and in fetuses that underwent an obstetric intervention (odds ratio, 2.8; 95% confidence interval: 1.8, 23.6; P = .006). Conclusion: Brain injury of the surviving co-twin after SIUD in MC pregnancies is usually of ischemic origin and spares the brainstem and cerebellum. Focal brain lesions are more frequent in pregnancies complicated by TTTS or in those where an intervention has been performed.

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