Early Detection of Ischemic Brain Injuries by Diffusion-Weighted Imaging After Radiofrequency Ablation for Fetal Reduction in Monochorionic Pregnancies Publisher Pubmed



Moradi B^{1, 2} ; Badraqe N² ; Rahimisharbaf F³ ; Firouznia K² ; Shirazi M³ ; Kazemi MA^{2, 4} ; Rahimi R² Show Affiliations
Source: Journal of Clinical Ultrasound Published:2022

Abstract

Background: This study aimed to investigate the additional advantages of magnetic resonance imaging (MRI), particularly diffusion-weighted imaging (DWI) over fetal ultrasound in the detection of acute ischemic cerebral injuries in complicated monochorionic (MC) pregnancies that underwent selective reduction by radiofrequency ablation (RFA). Methods: This prospective cohort study was conducted on 40 women with complicated MC pregnancies who were treated by RFA. Fetal brain imaging by DWI and conventional MRI was performed either in the early (within 10 days after RFA) or late phase (after 3–6 weeks) in the surviving fetuses to detect both acute and chronic ischemic injuries. The presence of anemia after RFA was also evaluated by Doppler ultrasound. Results: Overall, 13 of the total 43 fetuses (30.23%) demonstrated MRI abnormalities with normal brain ultrasound results including germinal matrix hemorrhage (GMH), extensive cerebral ischemia, and mild ventriculomegaly. Although seven fetuses with GMH eventually survived, fetuses that demonstrated ischemic lesions and ventriculomegaly on MRI died in the uterus. Conclusion: The absence of abnormal cerebral lesions or anemia on ultrasound and Doppler exams does not necessarily rule out fetal brain ischemia. Performing early MRI, particularly DWI seems to be a reasonable option for detection of early intracranial ischemic changes and better management of complicated multiple pregnancies which were treated by RFA. © 2022 Wiley Periodicals LLC.