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The prevalence of brain lesions after in utero surgery for twin-to-twin transfusion syndrome on third-trimester MRI: a retrospective cohort study

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Abstract

Objective

Due to the increased risk of antenatal brain lesions, we offer a third-trimester magnetic resonance imaging (MRI) scan to all patients who underwent an in utero intervention for twin-twin transfusion syndrome (TTTS). However, the usefulness of such a policy has not been demonstrated yet. Therefore, we determined the prevalence of antenatal brain lesions detected on third-trimester MRI and the proportion of lesions detected exclusively on MRI.

Materials and methods

We conducted a retrospective cohort study of monochorionic diamniotic twin pregnancies complicated by TTTS that underwent laser coagulation of the vascular anastomoses or fetal reduction by umbilical cord occlusion between 2010 and 2017. We reviewed the third-trimester MRI findings and compared those with the prenatal ultrasonography.

Results

Of the 141 patients treated with laser coagulation and 17 managed by cord occlusion, 112/141 (79%) and 15/17 (88%) patients reached 28 weeks. Of those, 69/112 (62%) and 11/15 (73%) underwent an MRI between 28 and 32 weeks. After laser coagulation, MRI detected an antenatal brain lesion in 6 of 69 pregnancies (9%) or in 6 of 125 fetuses (5%). In 4 cases (67%), the lesion was detected only on MRI. In the 11 patients treated with cord occlusion, no brain lesions were diagnosed.

Conclusion

The prevalence of brain lesions detected by third-trimester MRI is higher compared to prenatal ultrasonography alone, making MRI a useful adjunct to detect antenatal brain lesions in twin pregnancies after in utero treatment for TTTS.

Key Points

• In utero interventions for twin-to-twin transfusion syndrome (TTTS) do not prevent the occurrence of antenatal brain lesions.

• Fetal magnetic resonance imaging (MRI) has high accuracy in detecting anomalies of cortical development and can be a useful adjunct to ultrasonography in diagnosing certain brain abnormalities.

• After laser coagulation of the anastomoses for TTTS, third-trimester MRI diagnosed a brain lesion that was not detected earlier on ultrasound scan in 6% of pregnancies.

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Abbreviations

DWI:

Diffusion-weighted imaging

EPI:

Echo planar imaging

GA:

Gestational age

HASTE:

Half Fourier acquisition turbo spin echo

TAPS:

Twin anaemia polycythaemia sequence

TTTS:

Twin-twin transfusion syndrome

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Funding

This study has received funding by his study was funded by a grant from the Fund for Academic Research of the University Hospitals Leuven, Belgium; LL is the recipient of a grant of “Fonds voor Wetenschappelijk Onderzoek” (FWO grantnr: 1804718N).

Author information

Authors and Affiliations

  1. Department of Radiology, University Hospitals Leuven, Leuven, Belgium

    Michael Aertsen

  2. Department of Imaging and Pathology, Biomedical Sciences, KU Leuven, Leuven, Belgium

    Michael Aertsen

  3. Faculty of Medicine, KU Leuven, Leuven, Belgium

    Caroline Van Tieghem De Ten Berghe

  4. Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium

    Sanne Deneckere, Isabel Couck, Luc De Catte & Liesbeth Lewi

  5. Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium

    Isabel Couck, Luc De Catte & Liesbeth Lewi

  6. Fetal Medicine Unit, Department Obstetrics & Gynaecology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Isabel Couck, Luc De Catte & Liesbeth Lewi

Authors
  1. Michael Aertsen
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  2. Caroline Van Tieghem De Ten Berghe
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  3. Sanne Deneckere
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  4. Isabel Couck
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  5. Luc De Catte
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  6. Liesbeth Lewi
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Corresponding author

Correspondence to Liesbeth Lewi.

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Guarantor

The scientific guarantor of this publication is Prof. dr. Liesbeth Lewi.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two of the authors have significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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• retrospective

• observational

• performed at one institution

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Aertsen, M., Van Tieghem De Ten Berghe, C., Deneckere, S. et al. The prevalence of brain lesions after in utero surgery for twin-to-twin transfusion syndrome on third-trimester MRI: a retrospective cohort study. Eur Radiol 31, 4097–4103 (2021). https://doi.org/10.1007/s00330-020-07452-x

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  • DOI: https://doi.org/10.1007/s00330-020-07452-x

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