title: Early detection by diffusion-weighted sequence magnetic resonance imaging of severe brain lesions after fetoscopic laser coagulation for twin-twin transfusion syndrome.
abstract: OBJECTIVE
  Monochorionic twins treated by fetoscopic laser coagulation (FLC) for twin-twin transfusion syndrome (TTTS) are at increased risk of neurodevelopmental impairment. Our aim was to evaluate the additional value of diffusion-weighted imaging (DWI) over fetal sonography and T2 magnetic resonance imaging (MRI) in the detection of acute ischemic cerebral lesions shortly following FLC.
  
  
  METHODS
  This was a prospective cohort study of fetuses with TTTS treated by FLC. All fetuses underwent brain DWI and T2-MRI within 24-96 h after the procedure and a follow-up MRI at 30-32 weeks' gestation. All fetuses also had frequent ultrasound evaluation until delivery.
  
  
  RESULTS
  Thirty pregnancies with TTTS were included in the study. Eight resulted in survival of only one twin after the procedure (Group A), while the other 22 pregnancies resulted in the survival of both twins (Group B), as assessed at the time of initial MRI. Two fetuses in Group A and four in Group B had evidence of transient bleeding in the germinal matrix. Three fetuses in Group B and none in Group A had diffuse ischemic changes in the white matter. One fetus died in utero 24 h after MRI. The other two fetuses in Group B demonstrated an acute infarct 24-48 h after the procedure. Subsequent scans at 28-29 and 32 weeks showed brain atrophy compatible with an old infarct.
  
  
  CONCLUSIONS
  DWI can demonstrate cerebral damage immediately after FLC. Larger cohorts are needed to determine the role of fetal MRI in the prenatal assessment and follow-up of patients with TTTS.
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: B
authors.initials: B
authors.lastname: Weisz
authors.forename: C
authors.initials: C
authors.lastname: Hoffmann
authors.forename: S
authors.initials: S
authors.lastname: Ben-Baruch
authors.forename: Y
authors.initials: Y
authors.lastname: Yinon
authors.forename: L
authors.initials: L
authors.lastname: Gindes
authors.forename: E
authors.initials: E
authors.lastname: Katorza
authors.forename: A
authors.initials: A
authors.lastname: Shrim
authors.forename: O
authors.initials: O
authors.lastname: Bar Yosef
authors.forename: E
authors.initials: E
authors.lastname: Schiff
authors.forename: S
authors.initials: S
authors.lastname: Lipitz
mesh_terms: D020520:Brain Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D002545:Brain Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005330:Fetofetal Transfusion / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
keywords: MRI; TTTS; monochorionic twins; ultrasound