Fetal MRI of thoraco-omphalopagus conjoined twins.

Abdullah H, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-219793 Description Conjoined twins are very rare with incidence of 1 per 250 000 live births. Fetal MRI is an important adjunct to ultrasound particularly in evaluation of complex fetal anomalies and organ positions. 3 This case report illustrates our first experience in MRI fetal of conjoined twins with the current available sequences. An 18-year-old G2 P0+1, with no known medical illness, was diagnosed with conjoined twin pregnancy from antenatal ultrasound at 28 weeks. MRI of pelvis was performed using a 1.5 T Phillips using torso array coil. Sequences employed were Coronal T2 FB (free breathing), Axial T2 FB, Sagittal T2 FB, BB_SSh_Rtrig SE, Axial BTFE and BB_SSh_RTrig SE. The effective time echoof 188 s, 10 mm slice thickness. Each slice was performed in 2s, and the full sequences in each imaging plane require 27 s, 256×256 matrix and 34 cm field of view. It showed conjoined twins with single and fused heart, and liver represented a thoraco-omphalopagus presentation (figure 1). The images from MRI allow counselling with the parents regarding poor prognosis of the non-operable fused heart and liver (figure 2). The patient underwent emergency caesarean section due to premature labour. Two baby girls were found to be joined at the thorax and abdomen (fused heart and liver) with single umbilical cord insertion. The patients succumbed to death due to heart failure at day 2 of life. In our experience, the most useful MRI sequence is T2 FB in all three planes. The advent of fast acquisition sequences in MRI technology allows better images by minimising movement and breathing artefacts. Fetal MRI of thoraco-omphalopagus conjoined twins