{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:38:10Z","timestamp":1791437890605,"version":"4.3.3"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,4,1]],"date-time":"2022-04-01T00:00:00Z","timestamp":1648771200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Monochorionic twin pregnancies are at increased risk of single intrauterine death (sIUD) and subsequent brain injury in the surviving twin owing to shared placentation. We assessed the association between middle cerebral artery peak systolic velocity (MCA\u2010PSV) and cerebral injury on magnetic resonance imaging (MRI) and examined the association between cerebral findings on diffusion\u2010weighted imaging (DWI) and those on T2\u2010weighted imaging following spontaneous sIUD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort study of monochorionic pregnancies complicated by spontaneous sIUD followed at a tertiary center between January 2008 and January 2020. Pregnancies with sIUD following laser treatment, those with selective feticide, double IUD occurring on the same day or sIUD before 14\u2009weeks' gestation were excluded, as were cases in which MCA\u2010PSV was not measured or DWI\u2010MRI was not performed. The ability of MCA\u2010PSV Doppler to predict subsequent cerebral injury on MRI was assessed, and DWI findings were analyzed and compared with those on susceptibility\u2010weighted imaging (SWI) and T2\u2010weighted MRI to determine its diagnostic accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We assessed 64 monochorionic pregnancies complicated by spontaneous sIUD. Of these, 47 (73.4%) pregnancies underwent fetal brain MRI and met the inclusion criteria. Sixteen (34.0%) of these fetuses demonstrated cerebral injury on MRI. The median interval between the diagnosis of sIUD and MRI examination was 5\u2009days. Fetuses with increased MCA\u2010PSV &gt;\u20091.5\u2009multiples of the median (MoM) following sIUD were significantly more likely to demonstrate cerebral injury on MRI than were those with normal MCA\u2010PSV (68.8% <jats:italic>vs<\/jats:italic> 38.7%; <jats:italic>P<\/jats:italic>\u2009=\u20090.05). The sensitivity and specificity of MCA\u2010PSV &gt;\u20091.5\u2009MoM for predicting cerebral injury on MRI were 68.8% (95%\u2009CI, 41.3\u201388.9%) and 61.3% (95%\u2009CI, 42.2\u201378.2%), respectively. Patterns of early cerebral injury on T2\u2010weighted and SWI\u2010MRI included acute or subacute tissue swelling (<jats:italic>n<\/jats:italic>\u2009=\u20096), parenchymal atrophy (<jats:italic>n<\/jats:italic>\u2009=\u20097), loss of cortical ribbon (<jats:italic>n<\/jats:italic>\u2009=\u20091) and hemorrhage (<jats:italic>n<\/jats:italic>\u2009=\u20098). Early MRI within approximately 2\u2009weeks after the diagnosis of sIUD demonstrated abnormal DWI along with coexisting SWI and T2\u2010weighted sequelae in 56.3% (9\/16) of cases. When DWI was normal and a second MRI examination was performed later (<jats:italic>n<\/jats:italic>\u2009=\u20097), there were no ischemic changes evident on T2\u2010weighted imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Increased MCA\u2010PSV is associated with, but predicts poorly, cerebral injury after sIUD. Early MRI with DWI within approximately 2\u2009weeks after the diagnosis of sIUD is valuable in identifying any cerebral injury. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.24844","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T15:36:51Z","timestamp":1640273811000},"page":"497-505","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Early imaging predictors of fetal cerebral ischemic injury in monochorionic twin pregnancy complicated by spontaneous single intrauterine death"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6352-4846","authenticated-orcid":false,"given":"S.","family":"Shinar","sequence":"first","affiliation":[{"name":"Ontario Fetal Centre, Division of Maternal\u2013Fetal Medicine, Department of Obstetrics and Gynaecology Mount Sinai Hospital, University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Harris","sequence":"additional","affiliation":[{"name":"Ontario Fetal Centre, Division of Maternal\u2013Fetal Medicine, Department of Obstetrics and Gynaecology Mount Sinai Hospital, University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Van Mieghem","sequence":"additional","affiliation":[{"name":"Ontario Fetal Centre, Division of Maternal\u2013Fetal Medicine, Department of Obstetrics and Gynaecology Mount Sinai Hospital, University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9884-5778","authenticated-orcid":false,"given":"L.","family":"Lewi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospitals Leuven Department of Development and Regeneration  KU Leuven, Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. M.","family":"Morency","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2013Fetal Medicine, Department of Obstetrics and Gynecology McGill University, Royal Victoria Hospital\u00a0\u2013\u00a0MUHC Glen Site  Montreal, QC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Blaser","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging, Hospital for Sick Children, Department of Medical Imaging University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Ontario Fetal Centre, Division of Maternal\u2013Fetal Medicine, Department of Obstetrics and Gynaecology Mount Sinai Hospital, University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,4]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.21925"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000500774"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15530"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200001063420102"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1067\/S0002-9378(03)00644-6"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A0754"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.4078"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.4449"},{"key":"e_1_2_7_10_1","first-page":"799","article-title":"Apparent diffusion coefficient determination in normal fetal brain: a prenatal MR imaging study","volume":"24","author":"Righini A","year":"2003","journal-title":"AJNR Am J Neuroradiol"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-017-3965-z"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3279"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5059"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.2701"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1999.14050297.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2017.08.014"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1013"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2012-0019"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2020.01.050"},{"key":"e_1_2_7_20_1","first-page":"1563","article-title":"Contribution of fetal MR imaging in the evaluation of cerebral ischemic lesions","volume":"25","author":"Garel C","year":"2004","journal-title":"AJNR Am J Neuroradiol"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13283"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2922"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2202"},{"key":"e_1_2_7_24_1","first-page":"149","volume-title":"Multiple Pregnancy","author":"Ong S","year":"2006"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004728-200401000-00014"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14722"}],"container-title":["Ultrasound in Obstetrics &amp; 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