Background This study aimed to investigate the additional advantages of magnetic resonance imaging (MRI), particularly diffusion‐weighted imaging (DWI) over fetal ultrasound in the detection of acute ischemic cerebral injuries in complicated monochorionic (MC) pregnancies that underwent selective reduction by radiofrequency ablation (RFA). Methods This prospective cohort study was conducted on 40 women with complicated MC pregnancies who were treated by RFA. Fetal brain imaging by DWI and conventional MRI was performed either in the early (within 10 days after RFA) or late phase (after 3–6 weeks) in the surviving fetuses to detect both acute and chronic ischemic injuries. The presence of anemia after RFA was also evaluated by Doppler ultrasound. Results Overall, 13 of the total 43 fetuses (30.23%) demonstrated MRI abnormalities with normal brain ultrasound results including germinal matrix hemorrhage (GMH), extensive cerebral ischemia, and mild ventriculomegaly. Although seven fetuses with GMH eventually survived, fetuses that demonstrated ischemic lesions and ventriculomegaly on MRI died in the uterus. Conclusion The absence of abnormal cerebral lesions or anemia on ultrasound and Doppler exams does not necessarily rule out fetal brain ischemia. Performing early MRI, particularly DWI seems to be a reasonable option for detection of early intracranial ischemic changes and better management of complicated multiple pregnancies which were treated by RFA.

Background: Despite technological advancements in perinatal imaging, autopsy examination is still regarded as the reference standard to determine the time and reason of the fetal death. Purpose: This study was conducted to identify the intrauterine postmortem magnetic resonance imaging (PMMR) findings of fetuses, who underwent radiofrequency ablation (RFA). Study Type: Prospective. Population: Fifty-three twin/triplet complicated pregnancies scheduled for selective reduction of one of the fetuses by RFA were included. Field Strength/Sequence: The imaging methods used are T1-weighted gradient-echo imaging (T1 GRE), T2 half-Fourier acquisition single-shot turbo spin-echo (SSTSE), and diffusion-weighted imaging (DWI) sequences. Assessment: The MRIs were interpreted by three radiologists. Statistical Tests: Data were analyzed using the software package SPSS Statistics Version 22.0. The used tests included one-way analysis of variance (ANOVA) and Duncan tests (significance level: P value <0.05). This analysis was performed with scikit-learn library (version 1.1.1) in Python version 3.9. Results: Average PMMR scores of orbit, brain, and abdomen showed significant differences among different PM interval subgroups. The brain apparent diffusion coefficient (ADC) numbers of reduced and living fetuses were significantly different at any PM interval. To determine which findings are closely associated with the timing of fetal death, five different methods of feature selection were employed. The top eight selected features achieved the highest area under the curve (AUC) of 78.19%. Data Conclusion: In utero, PMMR findings may be associated with the time of fetal death. Among different fetal organs evaluated, particularly PMMR top eight features specifically scores of orbits were associated with PM intrauterine time after death. Level of Evidence: 2 Technical Efficacy: Stage 2

Objectives: To evaluate the optic nerve sheath diameter (ONSD) in pre-eclamptics and compare with those of normotensive pregnant women. Methods: This was a comparative descriptive cross-sectional study of 120 pre-eclamptics and 120 normotensive pregnant women in Ilorin, Nigeria. Transocular scan was performed in longitudinal and transverse planes for each eye using SonoscapeS30 ultrasound machine equipped with a high frequency (9.5-15MHz) linear probe. Three measurements were obtained at 3 mm behind the globe in each plane, making six for each eye and 12 for both. The average for each eye was calculated and the average for both eyes was taken as the mean ONSD for each participant. Results: The mean ONSD of normotensive pregnant women was 4.37 ± 0.44 mm while that of pre-eclamptics was 4.90 ± 0.72 mm (p = <0.001). There was a strong positive correlation between ONSD in pre-eclamptics and the severity of pre-eclampsia (p = <0.001). The incidence of increased ONSD (>5 mm) was 35% in pre-eclamptics and 5.8% in normotensives (p = <0.001). The average ONSD on the left (4.96 ± 0.73 mm) was significantly higher than the right (4.84 ± 0.74 mm) in pre-eclamptics (p = <0.001). However, no significant difference was observed in normotensives (4.38 ± 0.47 mm left) (4.35 ± 0.48 mm right) (p = 0.379). There was no significant correlation between ONSD and gestational age in both groups (p = 0.179 pre-eclamptics, p = 0.709 normotensives) as well as between ONSD and parity (p = 0.060 pre-eclamptics, p = 0.929 normotensives). Conclusions: ONSD was significantly increased in pre-eclamptics compared to normotensive pregnant women. Mean ONSD increases with the severity of pre-eclampsia. ONSD has been shown to be a marker of increased intracranial pressure in pre-eclamptics. Its routine measurement will assist in the early detection and monitoring of these patients thus, reducing the morbidity and mortality associated with this condition.