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Twin discordance: a study of volumetric fetal brain MRI and neurodevelopmental outcome

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

This study employed magnetic resonance imaging (MRI) to compare brain volumes of discordant twins and examined their neurodevelopment after birth by using a validated exam.

Study design

A prospective historical cohort study of discordant dichorionic diamniotic (DCDA) or monochorionic diamniotic (MCDA) twin fetuses, who undergone an MRI scan to evaluate growth restriction in the discordant twin (weight < 10th centile) during 6 years period, at a single tertiary center. Twenty-seven twin pairs were included in the volumetric study and 17 pairs were included in the neurodevelopmental outcome examination. The volumes of the supratentorial brain region, both hemispheres, eyes, and the cerebellum were measured by 3D MRI semi-automated volume measurements. Volumes were plotted on normal growth curves and discordance was compared between weight at birth and brain structure volumes. Neurodevelopmental outcome was evaluated using the VABS-II questionnaire at a mean age of 4.9 years.

Results

The volume of major brain structures was significantly larger in the appropriate-for-gestational-age twins (AGA) compared to the small-for-gestational-age (SGA) co-twins (p < 0.001). The birth weight discordance was 32.3% (24.9–48.6) and was significantly greater (p < 0.001) than the discordance of the prenatal supratentorial brain (13.6% [5.6–18]), cerebellum volume (21.7% [9.5–30.8]). Further neurodevelopmental outcome evaluation found no significant difference between the AGA twin and the SGA twin.

Conclusion

In discordant twins, the smaller twin showed a “brain-preserving effect,” which in our study was not associated with a worse neurodevelopmental outcome. The use of MRI in such cases may aid in decision-making and parental consultation.

Key Points

• Weight discordance at birth was significantly greater compared to intrauterine brain volume discordance measured by 3D MRI.

• Small-for-gestational-age (SGA) fetuses preserve brain development.

• In highly discordant twins, there was no long-term difference in neurodevelopmental outcome at a mean age of 4.9 years.

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Abbreviations

AEDF:

Absent end-diastolic flow

AGA:

Appropriate for gestational age

CGH:

Comparative genomic hybridization

CV:

Cerebellum volume

DCDA:

Dichorionic diamniotic

FGR:

Fetal growth restriction

HC:

Head circumference

IUGR:

Intrauterine growth restriction

LEBV:

Left eyeball volume

LHV:

Left hemisphere volume

MCDA:

Monochorionic diamniotic

MRI :

Magnetic resonance imaging

REBV:

Right eyeball volume

REDF:

Reversed end-diastolic flow

RHV:

Right hemisphere volume

SGA:

Small for gestational age

STV:

Supratentorial volume

US:

Ultrasonography

VABS:

Vineland Adaptive Behavior Scales

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat Gan, Israel

    Tom Halevy, Jorden Halevy & Eldad Katorza

  2. Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel

    Meirav Nezer & Eran Barzilay

  3. Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel

    Meirav Nezer & Eran Barzilay

  4. School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Tomer Ziv-Baran

  5. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Eldad Katorza

Authors
  1. Tom Halevy
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  2. Meirav Nezer
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  3. Jorden Halevy
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  4. Tomer Ziv-Baran
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Corresponding author

Correspondence to Tom Halevy.

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Guarantor

The scientific guarantor of this publication is Prof. Eldad Katorza MD, MSC, MBA.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Tomer Ziv Baran, PhD, kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional Review Board approval was obtained: 0256-13-SMC.

Methodology

• Prospective historical cohort

• Diagnostic or prognostic study

• Performed at one institution

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Halevy, T., Nezer, M., Halevy, J. et al. Twin discordance: a study of volumetric fetal brain MRI and neurodevelopmental outcome. Eur Radiol 31, 6676–6685 (2021). https://doi.org/10.1007/s00330-021-07773-5

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  • DOI: https://doi.org/10.1007/s00330-021-07773-5

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