Skip to main content

Abstract

With the increasing age of pregnant women and the increasing number of conceptions achieved with use of assisted reproduction technology, there is an increasing number of multifetal pregnancies and an increasing need for prenatal diagnosis and especially for noninvasive diagnostic techniques, including diagnostic imaging techniques. MRI more and more often becomes necessary for counseling parents on treatment options and possible outcomes.

Dizygotic twins are always dichorionic (DC). Monozygotic twins may be dichorionic or monochorionic (MC). MC twins may be diamniotic (DA) or monoamniotic (MA). MC twins are at high risk for adverse outcome due to complications related to placental vascular anastomoses: twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia syndrome (TAPS), growth discordance, and twin reversed-arterial-perfusion syndrome (TRAPS). That is why it is chorionicity that determines fetal outcome in twin pregnancies with monochorionic monozygosity being the greatest exposure to anomalies and death.

Any congenital malformation seen in a singleton pregnancy can occur in multiple gestation, and its imaging characteristics are the same as described in the previous chapters.

MRI of twin pregnancies is more time consuming because there are two fetuses to be examined and evaluated and because twins are much more mobile than singletons, especially in earlier gestation.

Twins are not the same as two single fetuses – for example, the normal development of the brains of twins differs from that in singleton pregnancies. This has to be taken into consideration when interpreting the findings and comparing them to the existing atlases or other sources of normal images and measurements’ values.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Brown CE, Weinreb JC (1988) Magnetic resonance imaging appearance of growth retardation in a twin pregnancy. Obstet Gynecol 71(6 Pt 2):987–988

    CAS  PubMed  Google Scholar 

  2. Blickstein I (2014) MC twining as an embryonic accident. In: Materials of twins 2014: the joint 3rd world congress on twin pregnancy a global perspective and the 15th congress of the international society twin studies (ISTS), Budapest, 16–19 Nov 2014

    Google Scholar 

  3. Krampl-Bettelheim E (2011) Problems of multiple pregnancies. Ultrasound and MRI. In: Prayer D (ed) Fetal MRI. Springer, Berlin/Heidelberg, pp 443–452

    Google Scholar 

  4. Baldwin VJ (ed) (1994) Pathology of multiple pregnancy. Springer, New York

    Google Scholar 

  5. Khalil A, Townsend R, Papageorghiou A et al (2014) Crown-rump length discordance and fetal structural abnormalities in twin pregnancies. In: Best 15 abstracts in the obstetrical and gynecological field. The joint 3rd world congress on twin pregnancy a global perspective and the 15th congress of the international society twin studies (ISTS), Budapest, 16–19 Nov 2014

    Google Scholar 

  6. Griffiths PD, Russell SA, Mason G et al (2012) The use of in utero MR imaging to delineate developmental brain abnormalities in multifetal pregnancies. AJNR Am J Neuroradiol 33(2):359–365

    Article  CAS  PubMed  Google Scholar 

  7. Dubois J, Benders M, Borradori-Tolsa C et al (2008) Primary cortical folding in the human newborn: an early marker of later functional development. Brain 131(Pt 8):2028–2041

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Knickmeyer RC, Kang C, Woolson S et al (2011) Twin-singleton differences in neonatal brain structure. Twin Res Hum Genet 14(3):268–276

    Article  PubMed Central  PubMed  Google Scholar 

  9. Smith APM (2000) Abnormalities of twin pregnancies. In: McHugo JM, Pilling DW, Twining P (eds) Textbook of fetal abnormalities. Churchill Livingstone, London/New York, pp 389–410

    Google Scholar 

  10. Amiel-Tison C, Pettigrew AG (1991) Adaptive changes in the developing brain during intrauterine stress. Brain Dev 13(2):67–76

    Article  CAS  PubMed  Google Scholar 

  11. Sokol R (2014) Timing of delivery of twins. Materials of twins 2014: the joint 3rd world congress on twin pregnancy a global perspective and the 15th congress of the international society twin studies (ISTS), Budapest, 16–19 Nov 2014

    Google Scholar 

  12. Sebire NJ, Sepulveda W, Jeanry P, Nyberg DA, Nicolaides KH (2003) Multiple gestations. In: Nyberg DA, McGahan JP, Pretorius DH, Pilu G (eds) Diagnostic imaging of fetal anomalies. Lippincott Williams & Wilkins, Philadelphia, pp 777–814

    Google Scholar 

  13. Hu LS, Caire J, Twickler DM (2006) MR findings of complicated multifetal gestations. Pediatr Radiol 36(1):76–81

    Article  PubMed  Google Scholar 

  14. Bekiesinska-Figatowska M, Herman-Sucharska I, Romaniuk-Doroszewska A et al (2013) Diagnostic problems in case of twin pregnancies – US versus MRI study. J Perinat Med 41(5):535–541

    Article  PubMed  Google Scholar 

  15. Rochon M, Stone J (2003) Invasive procedures in multiple gestations. Curr Opin Obstet Gynecol 15(2):167–175

    Article  PubMed  Google Scholar 

  16. Blickstein I, Perlman S (2013) Single fetal death in twin gestations. J Perinat Med 41:65–69

    Article  PubMed  Google Scholar 

  17. Senat MV (2009) Intrauterine death and twin pregnancy. J Gynecol Obstet Biol Reprod (Paris) 38(8 Suppl):S100–S103

    Article  Google Scholar 

  18. Hoffmann C, Weisz B, Yinon Y et al (2013) Diffusion MRI findings in monochorionic twin pregnancies after intrauterine fetal death. AJNR Am J Neuroradiol 34(1):212–216

    Article  CAS  PubMed  Google Scholar 

  19. Quintero RA, Morales WJ, Allen MH et al (1999) Staging of twin-twin transfusion syndrome. J Perinatol 19:550–555

    Article  CAS  PubMed  Google Scholar 

  20. Kline-Fath BM, Calvo-Garcia MA, O’Hara SM et al (2007) Twin-twin transfusion syndrome: cerebral ischemia is not the only fetal MR imaging finding. Pediatr Radiol 37:47–56

    Article  PubMed  Google Scholar 

  21. Spruijt M, Steggerda S, Rath M et al (2012) Cerebral injury in twin-twin transfusion syndrome treated with fetoscopic laser surgery. Obstet Gynecol 120(1):15–20

    Article  PubMed  Google Scholar 

  22. Kilby M (2014) Fetal brain injury in survivors of twin pregnancies complicated by demise of one twin as assessed by in utero MR imaging. In: Materials of twins 2014: the joint 3rd world congress on twin pregnancy a global perspective and the 15th congress of the international society twin studies (ISTS), Budapest, 16–19 Nov 2014

    Google Scholar 

  23. Weisz B, Hoffmann C, Ben-Baruch S et al (2014) Early detection by diffusion-weighted sequence magnetic resonance imaging of severe brain lesions after fetoscopic laser coagulation for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol 44(1):44–49

    Article  CAS  PubMed  Google Scholar 

  24. Quarello E, Molho M, Ville Y (2007) Incidence, mechanisms, and patterns of fetal cerebral lesions in twin-to-twin transfusion syndrome. J Matern Fetal Neonatal Med 20(8):589–597

    Article  PubMed  Google Scholar 

  25. Jelin AC, Norton ME, Bartha AI et al (2008) Intracranial magnetic resonance imaging findings in the surviving fetus after spontaneous monochorionic cotwin demise. Am J Obstet Gynecol 199(4):398.e1–398.e5

    Article  Google Scholar 

  26. Manning N (2014) Cardiac manifestations of TTTS, Functional and acquired cardiovascular anomalies in monochorionic twins. In: Materials of twins 2014: the joint 3rd world congress on twin pregnancy a global perspective and the 15th congress of the international society twin studies (ISTS), Budapest, 16–19 Nov 2014

    Google Scholar 

  27. Guimaraes CV, Kline-Fath BM, Linam LE et al (2011) MRI findings in multifetal pregnancies complicated by twin reversed arterial perfusion sequence (TRAP). Pediatr Radiol 41(6):694–701

    Article  PubMed  Google Scholar 

  28. Azian AA, Roslani AL (2011) Acardius amorphus: magnetic resonance imaging (MRI) can be helpful in the diagnosis when ultrasound (US) is inconclusive. Med J Malaysia 66(5):510–512

    CAS  PubMed  Google Scholar 

  29. Spencer R (1996) Anatomic description of conjoined twins: a plea for standardized terminology. J Pediatr Surg 31:941–944

    Article  CAS  PubMed  Google Scholar 

  30. McHugh K, Kiely EM, Spitz L (2006) Imaging of conjoined twins. Pediatr Radiol 36(9):899–910

    Article  PubMed  Google Scholar 

  31. Bekiesinska-Figatowska M, Herman-Sucharska I, Duczkowska A et al (2013) Prenatal MRI as a method of controlling fetal pathology. Ginekol Pol 84(6):436–443

    PubMed  Google Scholar 

  32. Leithner K (2011) The psychic state of the pregnant woman and prenatal diagnostic procedures. In: Prayer D (ed) Fetal MRI. Springer, Berlin, pp 55–64

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Monika Bekiesinska-Figatowska MD, PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Bekiesinska-Figatowska, M. (2016). MR Imaging of Multiple Gestations. In: Masselli, G. (eds) MRI of Fetal and Maternal Diseases in Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-319-21428-3_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-21428-3_12

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21427-6

  • Online ISBN: 978-3-319-21428-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics