Fetal neurodevelopmental recovery in donors after laser surgery for twin-twin transfusion syndrome.
Fetal neurodevelopmental recovery in donors after laser surgery for twin-twin transfusion syndrome.
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DOI：
10.1002/pd.5866
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发表时间：
2021-01
影响因子：
3
通讯作者：
Chmait RH
中科院分区：
文献类型：
--
作者：
Rajagopalan V;Ashouri K;Llanes A;Vanderbilt DL;Lepore N;Bluml S;Lai HA;Wisnowski J;Chon AH;Chmait RH
胎儿磁共振成像 (MRI) 和光谱学 (MRS) 为非侵入性测量双胎输血综合征 (TTTS) 幸存者的神经发育标志物提供了独特的机会。通过使用胎儿 MRI + MRS 测量脑体积和脑代谢物浓度来表征 TTTS 激光手术后胎儿大脑的成熟情况。采用激光手术治疗 TTTS 的双存活胎儿的前瞻性研究。术后 4-5 周，胎儿 MRI 与新颖的图像分析结合使用，自动提取主要脑组织体积。胎儿 MRS 用于测量胎儿大脑中主要代谢物的浓度。研究了二十一对双胞胎。 MRI 的平均 (±SD) 孕龄为 25.89 (±2.37) 周。尽管双胞胎之间的脑容量没有差异，但捐赠者的总脑容量（TBV）较低。接受者的皮质和小脑体积比例较低，按 TBV 和脑体积标准化。磁共振成像数据显示，双胞胎大脑之间的生化差异与其大脑体积的差异有关。尽管与接受者相比，捐赠者的 TBV 较小，但捐赠者的脑组织体积比例得以保留。胎儿大脑发育的 MRS 成熟标志物显示，捐献者的恢复持续到手术后 4 周。
Fetal magnetic resonance imaging (MRI) and spectroscopy (MRS) provide a unique opportunity to non-invasively measure markers of neurodevelopment in survivors of twin-twin transfusion syndrome (TTTS). To characterize fetal brain maturation after laser surgery for TTTS by measuring brain volumes and cerebral metabolite concentrations using fetal MRI + MRS. Prospective study of dual surviving fetuses treated with laser surgery for TTTS. At 4–5 postoperative weeks, fetal MRI was used together with novel image analysis to automatically extract major brain tissue volumes. Fetal MRS was used to measure major metabolite concentrations in the fetal brain. Twenty-one twin pairs were studied. The average (±SD) gestational age at MRI was 25.89 (±2.37) weeks. Total brain volume (TBV) was lower in the donors, although cerebral volumes were not different between twin pairs. Recipients showed lower proportions of cortical and cerebellar volumes, normalized to TBV and cerebral volumes. MRS data showed that biochemical differences between twin brains were related to discrepancy in their brain volumes. Although donors have a smaller TBV compared to recipients, proportionality of brain tissue volumes are preserved in donors. MRS maturational markers of fetal brain development show that recovery in donors persists 4 weeks after surgery.
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