MRI findings in multifetal pregnancies complicated by twin reversed arterial perfusion sequence (TRAP)
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Carolina V. A. Guimaraes & Beth M. Kline-Fath & Leann E. Linam & Maria A. Calvo Garcia & Eva I. Rubio & Foong-Yen Lim
- چاپ و سال / کشور: 2011
Description
Background Twin reversed arterial perfusion sequence (TRAP) is a rare complication in multifetal monochorionic pregnancies in which a normal “pump” twin provides circulation to an abnormal acardiac co-twin, resulting in high-output cardiac dysfunction in the pump twin. Objective To define fetal MRI findings of TRAP sequence. Materials and methods Fetal MR images were retrospectively reviewed in 35 pregnancies complicated by TRAP sequence. Abnormalities of the pump twin, acardiac twin, umbilical cord, placenta and amniotic fluid were reviewed. Results Acardiac twins were classified as: acephalus (51%), anceps (40%), amorphus (9%), acormus (0%). Common findings in acardiac twins include subcutaneous edema (77%), absent cardiac structures (86%), absent or abnormal thoracic cavity (100%), abnormal abdominal organs (100%), superior limbs absent (46%) or abnormal (51%), and inferior limbs present but abnormal (83%). There were pump twin findings of cardiac dysfunction in 43% and intracranial ischemic changes in 3%. Umbilical cord anomalies were present in 97%. Conclusion Acardiac twins present with a predictable pattern of malformation with poorly developed superior structures, more normally formed inferior structures and absent or rudimentary heart. Although usually absent, abnormal heart structures can be seen and do not exclude TRAP sequence. Pump twins are commonly normal with exception of findings of cardiac dysfunction and possible brain ischemia.
Pediatr Radiol (2011) 41:694–701 DOI 10.1007/s00247-010-1921-2 Received: 9 July 2010 / Revised: 19 October 2010 / Accepted: 1 November 2010 / Published online: 22 December 2010
