RT Journal Article
SR Electronic
T1 Altered Fetal Cerebral and Cerebellar Development in Twin-Twin Transfusion Syndrome
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A2922
A1 T. Tarui
A1 O.S. Khwaja
A1 J.A. Estroff
A1 J.N. Robinson
A1 M.C. Gregas
A1 P.E. Grant
YR 2012
UL http://www.ajnr.org/content/early/2012/02/02/ajnr.A2922.abstract
AB BACKGROUND AND PURPOSE: Neurodevelopmental disability is common in twins with TTTS in utero; however, the responsible neuropathology remains uncertain. We proposed to document the frequency of brain abnormalities on clinical fetal MR images and to determine if quantitative fetal brain biometric analysis in twin fetuses with TTTS was different from those in healthy control fetuses. MATERIALS AND METHODS: We reviewed the fetal brain MR images of 33 twin pairs with TTTS clinically evaluated in our institution. Eighteen fetal MR images of “healthy” twins with TTTS were further studied with biometric analysis in comparison with GA-matched singleton fetuses to detect quantitative differences in brain growth and development. RESULTS: A higher incidence of anomalies (11/33, 33.3%) was found than previously reported. The most frequent abnormality was ventriculomegaly (7/11, 63%) in both donor and recipient. In “healthy” twins with TTTS, biometric analysis revealed persistently small measurements (cBTD, CMT, TCD, and VAPD) in the donor cerebrum and cerebellum in comparison with their recipient cotwin and healthy control fetuses. These differences were preserved when normalized by cBTD. CONCLUSIONS: Our findings show that significant brain abnormalities are common in TTTS. In addition, diffuse subtle abnormalities are also present in normal-appearing donor fetal brains that cannot be solely explained by overall growth restriction. Such subtle fetal brain anomalies may explain the high incidence of poor long-term neurodevelopmental outcomes of survivors, and they need to be further investigated with more sophisticated quantitative fetal imaging methodologies. Abbreviations BPDbiparietal diametercBTDcerebral bitemporal distanceCMTcerebral mantle thicknessGAgestational agePVLperiventricular leukomalaciaTCDtransverse cerebellar diameterTTTStwin-twin transfusion syndromeVAPDvermian anteroposterior diameter