PDF(Pubmed)
Abstract：
OBJECTIVE: 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.
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.
摘要：
目的：描述产前诊断为双胎贫血-红细胞增多症（TAPS）的一系列单绒毛膜（MC）妊娠的胎儿脑磁共振成像（MRI）发现，因此，为了描述与这种情况相关的潜在颅内并发症，他们的频率和潜在的治疗选择。
方法：这是一项回顾性研究，涉及2006年至2023年在单一机构中并发TAPS并接受胎儿MRI的MC双胎妊娠。进行MRI控制，产后超声（US）或MRI可用。
结果：我们机构评估了1250例MC妊娠。50例怀孕（4%）被诊断为TAPS，29例接受了胎儿脑MRI检查。13/29例妊娠（44.8％）至少在双胞胎中表现出MRI的脑部发现。在14/57双胞胎（24.6％）中检测到神经放射学发现。我们发现了四个主要类别的发现：出血性病变，T2加权白质高强度（WMH），脑水肿肿胀和静脉充血。贫血者有19项发现，红细胞增多症双胞胎有3项发现，两组之间的比率具有统计学意义（p值=0.01）。宫内MRI随访显示出血性病变的后遗症。脑肿胀完全消退，治疗后显示静脉突出和T2-WMHs。产后影像学证实了产前特征。
结论：我们的工作表明，TAPS相关的MRI异常包括水肿/出血性病变，这些病变主要发生在贫血而不是红细胞增多的双胞胎中。胎儿镜激光手术可能具有潜在的减充血作用。因此,产前MRI可能有助于TAPS妊娠的咨询和管理，特别是治疗计划和疗效监测。
方法：这是一项回顾性研究，涉及2006年至2023年在单一机构中并发TAPS并接受胎儿MRI的MC双胎妊娠。进行MRI控制，产后超声（US）或MRI可用。
结果：我们机构评估了1250例MC妊娠。50例怀孕（4%）被诊断为TAPS，29例接受了胎儿脑MRI检查。13/29例妊娠（44.8％）至少在双胞胎中表现出MRI的脑部发现。在14/57双胞胎（24.6％）中检测到神经放射学发现。我们发现了四个主要类别的发现：出血性病变，T2加权白质高强度（WMH），脑水肿肿胀和静脉充血。贫血者有19项发现，红细胞增多症双胞胎有3项发现，两组之间的比率具有统计学意义（p值=0.01）。宫内MRI随访显示出血性病变的后遗症。脑肿胀完全消退，治疗后显示静脉突出和T2-WMHs。产后影像学证实了产前特征。
结论：我们的工作表明，TAPS相关的MRI异常包括水肿/出血性病变，这些病变主要发生在贫血而不是红细胞增多的双胞胎中。胎儿镜激光手术可能具有潜在的减充血作用。因此,产前MRI可能有助于TAPS妊娠的咨询和管理，特别是治疗计划和疗效监测。
