title: Visualisation of the vascular equator in twin-to-twin transfusion syndrome by virtual fetoscopy.
abstract: BACKGROUND
  Twin-to-twin transfusion syndrome (TTTS) is a serious complication of monochorionic twin gestation, which has a high risk of perinatal morbidity and mortality. Fetoscopic laser photocoagulation of the vascular anastomoses is the preferred treatment. Nowadays, Solomon technique which consists the vascular coagulation of all anastomoses in the placental equator is the preferable method.
  
  
  OBJECTIVE
  To develop a method of virtual fetoscopy by means of ultrasound and resonance magnetic imaging (MRI) scan data to allow the identification of placental equator.
  
  
  RESULTS
  MRI was performed in a twin monochorionic twin pregnancy with 28 weeks previously treated for TTTS with fetoscopic laser photocoagulation. A three-dimensional (3D) file of the placenta was created from overlapping image layers generated by MRI using Mimics software. Virtual fetoscopy allowed adequate visualization of fetuses, umbilical cord insertion and placental equator.
  
  
  CONCLUSIONS
  Virtual fetoscopy is a non-invasive technique which allowed adequate identification of placental equator, and it may be an important learning method to novice fetal endoscopic surgeons in TTTS cases.
authors.affiliation: Department of Radiology, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, RJ, Brazil.
authors.forename: Heron
authors.initials: H
authors.lastname: Werner
authors.affiliation: Instituto Nacional de Tecnologia, Desenho Industrial, Rio de Janeiro, RJ, Brazil.
authors.forename: Jorge Lopes
authors.initials: JL
authors.lastname: Dos Santos
authors.affiliation: Department of Maternal and Child, Fluminense Federal University (UFF), Niterói, RJ, Brazil.
authors.forename: Renato Augusto
authors.initials: RA
authors.lastname: Sá
authors.affiliation: Department of Radiology, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, RJ, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Daltro
authors.affiliation: Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
authors.forename: Emerson
authors.initials: E
authors.lastname: Gasparetto
authors.affiliation: Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
authors.forename: Edson
authors.initials: E
authors.lastname: Marchiori
authors.affiliation: Create Health Clinic, London, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Campbell
authors.affiliation: Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil. araujojred@terra.com.br.
authors.forename: Edward
authors.initials: E
authors.lastname: Araujo Júnior
mesh_terms: D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy; D005333:Fetus / Q000098:blood supply; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008279:Magnetic Resonance Imaging; D010920:Placenta / Q000098:blood supply / Q000473:pathology*; D011247:Pregnancy; D059285:Pregnancy, Twin; D014470:Umbilical Cord
keywords: Magnetic resonance imaging; Twin-to-twin transfusion syndrome; Virtual fetoscopy