Abstract
The incidence of conjoined twins is estimated to be around 1 in 250,000 live births. There is a distinct female predominance. In this paper the imaging of conjoined twins both antenatally and postnatally is reviewed, in particular taking into consideration recent advances with multidetector CT. Accurate counselling of parents regarding the likely outcome of the pregnancy and the likelihood of successful separation is dependent on good prenatal imaging with ultrasound and MRI. Planning of postnatal surgical separation is aided by accurate preoperative imaging which, depending on the conjoined area, will encompass many imaging modalities, but often relies heavily on CT scanning.
Similar content being viewed by others
References
Grassi R, Esposito V, Scaglione M, et al (2004) Multi-detector row CT for depicting anatomic features of cephalothoracopagus varieties: revised approach. Radiographics 24:e21
Barth RA, Filly RA, Goldberg JD, et al (1990) Conjoined twins: prenatal diagnosis and assessment of associated malformations. Radiology 177:201–207
Spencer R (2000) Theoretical and analytical embryology of conjoined twins: part I: embryogenesis. Clin Anat 13:36–53
Kingston CA, McHugh K, Kumaradevan J, et al (2001) Imaging in the preoperative assessment of conjoined twins. Radiographics 21:1187–1208
Pajkrt E, Jauniaux E (2005) First-trimester diagnosis of conjoined twins. Prenat Diagn 25:820–826
Vural F, Vural B (2005) First trimester diagnosis of dicephalic parapagus conjoined twins via transvaginal ultrasonography. J Clin Ultrasound 33:364–366
Maymon R, Mendelovic S, Schachter M, et al (2005) Diagnosis of conjoined twins before 16 weeks’ gestation: the 4-year experience of one medical center. Prenat Diagn 25:839–843
Chen PL, Choe KA (2003) Prenatal MRI of heteropagus twins. AJR 181:1676–1678
Norwitz ER, Hoyte LP, Jenkins KJ, et al (2000) Separation of conjoined twins with the twin reversed-arterial-perfusion sequence after prenatal planning with three-dimensional modelling. N Engl J Med 343:399–402
Martinez L, Fernandez J, Pastor I, et al (2003) The contribution of modern imaging to planning separation strategies in conjoined twins. Eur J Pediatr Surg 13:120–124
Mackenzie TC, Crombleholme TM, Johnson MP, et al (2002) The natural history of prenatally diagnosed conjoined twins. J Pediatr Surg 37:303–309
Spitz L, Kiely EM (2003) Conjoined twins. JAMA 289:1307–1310
Thomas JM (2004) Anaesthesia for conjoined twins. Childs Nerv Syst 20:538–546
van Ouwerkerk WJ, van den BR, Allison CE, et al (2004) Craniopagus: the Suriname-Amsterdam conjunction. Childs Nerv Syst 20:625–634
Pietrini D, Valenti M, Pusateri A, et al (2005) Perioperative management of face-to-face craniopagus twins separation. Paediatr Anaesth 15:519–524
Shank E, Manohar N, Schmidt U (2005) Anesthetic management for thoracopagus twins with complex cyanotic heart disease in the magnetic resonance imaging suite. Anesth Analg 100:361–364
Szmuk P, Ghelber O, Ezri T (2005) Difficult intubation in thoracopagus twins in MRI suite. Anesth Analg 101:1246
Andrews RE, McMahon CJ, Yates RW, et al (2005) Echocardiographic assessment of conjoined twins. Heart doi:10.1136/hrt.2005.069682
Wilcox DT, Quinn FM, Spitz L, et al (1998) Urological problems in conjoined twins. Br J Urol 81:905–910
Spencer R (2000) Theoretical and analytical embryology of conjoined twins: part II: adjustments to union. Clin Anat 13:97–120
Donaldson JS, Luck SR, Vogelzang R (1990) Preoperative CT and MR imaging of ischiopagus twins. J Comput Assist Tomogr 14:643–646
Spiegel DA, Ganley TJ, Akbarnia H, et al (2000) Congenital vertebral anomalies in ischiopagus and pyopagus conjoined twins. Clin Orthop Relat Res 381:137–144
Hockley AD, Gornall P, Walsh R, et al (2004) Management of pyopagus conjoined twins. Childs Nerv Syst 20:635–639
O’Connell JE (1976) Craniopagus twins: surgical anatomy and embryology and their implications. J Neurol Neurosurg Psychiatry 39:1–22
Walker M, Browd SR (2004) Craniopagus twins: embryology, classification, surgical anatomy, and separation. Childs Nerv Syst 20:554–566
Bucholz RD, Yoon KW, Shively RE (1987) Temporoparietal craniopagus. Case report and review of the literature. J Neurosurg 66:72–79
Swift DM, Weprin B, Sklar F, et al (2004) Total vertex craniopagus with crossed venous drainage: case report of successful surgical separation. Childs Nerv Syst 20:607–617
Christensen AM, Humphries SM, Goh KY, et al (2004) Advanced tactile medical imaging for separation surgeries of conjoined twins. Childs Nerv Syst 20:547–553
Ratan SK, Rattan KN, Magu S, et al (2004) Thoracolumbar rachipagus parasite. Pediatr Surg Int 20:298–300
Spencer R (1995) Rachipagus conjoined twins: they really do occur! Teratology 52:346–356
Gilbert-Barness E, Bich-Spicer D, Opitz JM (2003) Conjoined twins: morphogenesis of the heart and a review. Am J Med Genet A 120:568–582
Campbell S (2004) Separation of craniopagus twins: the Brisbane experience. Childs Nerv Syst 20:601–606
Author information
Authors and Affiliations
Corresponding author
Additional information
Not all the examinations presented as figures in this article were performed at our institution, but all these patients were referred to us for review. No patient therefore is identifiable from these anonymized images.
Rights and permissions
About this article
Cite this article
McHugh, K., Kiely, E.M. & Spitz, L. Imaging of conjoined twins. Pediatr Radiol 36, 899–910 (2006). https://doi.org/10.1007/s00247-006-0121-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-006-0121-6