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Reversible parenchymal ischemic injury on fetal brain MRI following fetoscopic laser coagulation—Implication on parental counseling

Radiology Case Reports. 2020;15(8):1369-1372

 

Journal Homepage

Journal Title: Radiology Case Reports

ISSN: 1930-0433 (Online)

Publisher: Elsevier

Society/Institution: University of Washington

LCC Subject Category: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine

Country of publisher: United States

Language of fulltext: English

Full-text formats available: PDF, HTML

 

AUTHORS


Shai Shrot, MD (Section of Neuroradiology, Department of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel, 2 Sheba Rd, Ramat-Gan 52621, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Corresponding author.)

Chen Hoffmann, MD (Section of Neuroradiology, Department of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel, 2 Sheba Rd, Ramat-Gan 52621, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)

Eldad Katorza, MD (Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel)

EDITORIAL INFORMATION

Double blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 8 weeks

 

Abstract | Full Text

We present a case of reversible extensive ischemic injury seen on fetal-brain MRI in a fetus following laser coagulation performed for treatment of severe twin-twin transfusion syndrome twin-twin transfusion syndrome. A 32-year-old pregnant mother presented with twin-twin transfusion syndrome. Following fetoscopic laser coagulation, intrauterine fetal death of the donor fetus was diagnosed. On fetal-brain MRI, multiple areas of restricted diffusion were noted, consistent with acute infarctions. Nevertheless, follow-up MRI showed only subtle parenchymal injury, also confirmed on postnatal brain MRI. Our case illustrates that ischemic injury, as depicted on diffusion-weighted imaging, might be reversible, possibly with reperfusion before irreversible insult follows. Two to 3 weeks follow-up fetal MRI might provide additional information on the extent of irreversible injury in cases of restricted diffusion seen on initial fetal-brain MRI and might assist in parental counseling regarding long-term sequela.