Role of MRI in Detecting Cerebral Anomalies and Cerebral Hypoperfusion in Surviving Twin after the Co Twin Demise of Monochorionic Twin Pregnancy
Kavitha Subramanian *
Department of Radiology and Imaging Sciences, Sri Ramachandra University, Chennai -600116, India.
Rajeswaran Rangasami
Department of Radiology and Imaging Sciences, Sri Ramachandra University, Chennai -600116, India.
Radhika Ramesh
Department of Obstetrics and Gynaecology, Sri Ramachandra University, Chennai -600116, India.
Chithra Andrew
Department of Obstetrics and Gynaecology, Sri Ramachandra University, Chennai -600116, India.
*Author to whom correspondence should be addressed.
Abstract
Aim: To demonstrate the role of MRI in detecting cerebral anomalies and cerebral hypo perfusion in surviving twin after the co twin demise of monochorionic twin pregnancy.
Case Presentation: 28 year old second gravida came for routine antenatal sonography at 29 weeks. Her routine anomaly scan at 20 weeks for her twin gestation was unremarkable. Present antenatal sonography revealed monochorionic diamniotic twin pregnancy with demise of one of the twins at 23 weeks. Ultrasound and doppler evaluation did not exhibit abnormality in surviving twin whereas MR evaluation revealed changes in feral brain due to ischaemia.
Discussion: Mono chorionic twin pregnancies are associated with numerous complications due to vascular anastomotic channels in the shared placenta. Complications include Twin to Twin Transfusion Syndrome, Anaemia - polycythemia sequence, selective intra uterine growth retardation, cotwin demise, neurological damage in surviving twin. Though prenatal Doppler sonography is often used for neurological assessment of the surviving twin, in utero Magnetic Resonance Imaging of foetal brain aids in definitive diagnosis of cerebral pathologies.
Conclusion: MRI plays an important role in assessing cerebral hypo perfusion injuries and cerebral anomalies
Keywords: Twin - twin transfusion syndrome, fetal MRI, co twin demise, cerebral ischaemia.