Dafi Bergman, Presenter: Nothing to Disclose

Boaz Weisz, Abstract Co-Author: Nothing to Disclose

Eldad Katorza, Abstract Co-Author: Nothing to Disclose

Gal Yaniv MD, PhD, Abstract Co-Author: Nothing to Disclose

Shlomo Lipitz, Abstract Co-Author: Nothing to Disclose

Eli Konen MD, Abstract Co-Author: Research Consultant, Valtech Cardio Ltd Research Consultant, Edwards Lifesciences Corporation Research Consultant, Sensible Medical Innovations Ltd Founder, RadLogics

Chen Chaim Hoffmann MD, Abstract Co-Author: Nothing to Disclose

Twin-to-Twin Transfusion Syndrome (TTTS) is a chronic hemodynamic disequilibrium affecting 10-15% of all monochorionic pregnancies. Modern treatments have dramatically decreased the mortality rate from TTTS, and in the same time focused great attention to the still significant morbidity, primarily neurocognitive morbidity. TTTS pregnancies are extensively monitored with ultrasound and post-natal neurological exams; however, fetal magnetic resonance imaging (MRI) and Diffusion-weighted imaging (DWI) are not yet commonly used, despite evidence that MRI can detect changes that are not apparent on prenatal ultrasound. In this study we have set off to assess the ADC changes in the brains of fetuses in pregnancies complicated with TTTS.

We have evaluated 53 DWI scans of fetuses afflicted by TTTS and 46 DWI scans of healthy singleton fetuses, in all of which ADC values from 8 regions of interest (ROIs) – frontal, parietal, temporal, occipital, basal ganglia, thalamus, pons and cerebellum, were plotted and compared using parametric and non-parametric tests.

We have found no significant differences in ADC values between the two groups, in any of the ROIs. Also, no significant differences were found in ADC values in any ROI between fetuses with or without co-twin demise. A non-parametric test comparing healthy controls to TTTS afflicted fetuses with and without pathological radiological findings have demonstrated significant difference between the three subgroups in the Basal ganglia (BG) ROI and Pons ROI. Comparison between the control group and the radiological pathology positive subgroup, using Mann-Whitney U Test, indicated a significant increase in ADC in the Pons ROI.

We observed that commonly used treatments for TTTS, do not evoke a significant changes in the diffusion of the fetal brain, even after a co-twin demise. Our data suggests the need for further investigation as to the meaning of pathological findings in fetal MRI scans and their correlations to neurocognitive injury in TTTS.

This study is the first using fetal brain DWI to assess neurological changes caused by TTTS. We hope it will lead to improved pre-natal evaluation and treatment choices as well as post-natal care.

Bergman, D, Weisz, B, Katorza, E, Yaniv, G, Lipitz, S, Konen, E, Hoffmann, C, Prenatal ADC Value Evaluation of the Fetal Brain in Monochorionic Twins with TTTS, and the Influence of Fetal Demise of One Fetus on the Surviving Sibling.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016847.html