Sun W, Chen L, Yin S, Cai A, Yang Z. Non-invasive dynamic observation of placental vascular anastomoses in monochorionic twins: Assessment using three-dimensional sonography combined with tomographic ultrasound imaging.
Placenta 2020;
95:84-90. [PMID:
32452406 DOI:
10.1016/j.placenta.2020.04.015]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION
Three-dimensional (3D) sonography combined with tomographic ultrasound imaging (TUI) to observe placental vascular anastomoses in monochorionic diamniotic (MCDA) twin pregnancies was evaluated.
METHODS
Women with MCDA twin pregnancies at a gestational age of 16-32 weeks were enrolled in this retrospective study. Placental anastomoses were detected using two-dimensional (2D) and 3D sonography. Two-dimensional data were obtained by color and spectral Doppler and 3D data with high-definition flow within the area between twins' umbilical cord insertions. Volume post-processing using TUI mode identified anastomoses. Anastomotic findings on ultrasound were compared with fetoscopic surgery or postnatally injected placentas for diagnostic value. Anastomoses detection was compared between the two imaging modalities.
RESULTS
Seventy-six twin pregnancies were analyzed: 11 selective intrauterine growth restrictions (sIUGR), 10 twin-to-twin transfusion syndrome (TTTS), and 55 without complications. Seventy-one twin pregnancies had arterio-arterial (AA) anastomoses and 75 had arterio-venous (AV) anastomoses. Three-dimensional sonography combined with TUI was more sensitive (87.3%) and accurate (88.2%) in detecting AA anastomoses than 2D sonography (74.6%, 76.3%, respectively; P < 0.05), but had comparable sensitivity for AV anastomoses. The specificity of both modalities for anastomoses was 100%. The detection rate of AA anastomoses by 3D modality was (40%) TTTS vs. (87.3%) normal (P < 0.05), but comparable (90.9%) for sIUGR. The detection rates of AV anastomoses (90%, 81.8%) in TTTS and sIUGR were comparable with (87.3%) normal (P > 0.05).
DISCUSSION
Three-dimensional sonography combined with TUI highlighted placental anastomoses and may be useful for the clinical diagnosis and therapy of MCDA twin complications.
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