title: Feasibility and reproducibility of diffusion-weighted magnetic resonance imaging of the fetal brain in twin-twin transfusion syndrome.
abstract: OBJECTIVE
  The aim of this study is to test the feasibility and reproducibility of diffusion-weighted magnetic resonance imaging (DW-MRI) evaluations of the fetal brains in cases of twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  From May 2011 to June 2012, 24 patients with severe TTTS underwent MRI scans for evaluation of the fetal brains. Datasets were analyzed offline on axial DW images and apparent diffusion coefficient (ADC) maps by two radiologists. The subjective evaluation was described as the absence or presence of water diffusion restriction. The objective evaluation was performed by the placement of 20-mm(2) circular regions of interest on the DW image and ADC maps. Subjective interobserver agreement was assessed by the kappa correlation coefficient. Objective intraobserver and interobserver agreements were assessed by proportionate Bland-Altman tests.
  
  
  RESULTS
  Seventy-four DW-MRI scans were performed. Sixty of them (81.1%) were considered to be of good quality. Agreement between the radiologists was 100% for the absence or presence of diffusion restriction of water. For both intraobserver and interobserver agreement of ADC measurements, proportionate Bland-Altman tests showed average percentage differences of less than 1.5% and 95% CI of less than 18% for all sites evaluated.
  
  
  CONCLUSIONS
  Our data demonstrate that DW-MRI evaluation of the fetal brain in TTTS is feasible and reproducible.
authors.affiliation: Department of Obstetrics and Gynecology, Professor José Aristodemo Pinotti Hospital, Center for Integral Assistance to Women's Health, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Orlando
authors.initials: O
authors.lastname: Gomes Neto
authors.forename: Marcos
authors.initials: M
authors.lastname: Marins
authors.forename: Rafael D
authors.initials: RD
authors.lastname: Botelho
authors.forename: Rafaela C
authors.initials: RC
authors.lastname: Nivoloni
authors.forename: Glauco E
authors.initials: GE
authors.lastname: Saura
authors.forename: Amábile
authors.initials: A
authors.lastname: Vessoni Arias
authors.forename: Ricardo
authors.initials: R
authors.lastname: Barini
authors.forename: Cleisson F A
authors.initials: CF
authors.lastname: Peralta
mesh_terms: D001921:Brain / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000473:pathology* / Q000601:surgery; D006801:Humans; D053685:Laser Therapy; D011247:Pregnancy; D015203:Reproducibility of Results