Pediatric Radiology

, Volume 41, Issue 6, pp 694–701 | Cite as

MRI findings in multifetal pregnancies complicated by twin reversed arterial perfusion sequence (TRAP)

  • Carolina V. A. Guimaraes
  • Beth M. Kline-Fath
  • Leann E. Linam
  • Maria A. Calvo Garcia
  • Eva I. Rubio
  • Foong-Yen Lim
Original Article



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.


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.


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%.


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.


Fetal MR Twin reversed arterial perfusion 


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Carolina V. A. Guimaraes
    • 1
  • Beth M. Kline-Fath
    • 1
  • Leann E. Linam
    • 1
  • Maria A. Calvo Garcia
    • 1
  • Eva I. Rubio
    • 1
  • Foong-Yen Lim
    • 2
  1. 1.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Division of Pediatric SurgeryCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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