Imaging in the Preoperative Assessment of Conjoined Twins

Kingston, Catherine A.; McHugh, Kieran; Kumaradevan, Jeevan; Kiely, Edward M.; Spitz, Lewis

doi:10.1148/radiographics.21.5.g01se011187

Cited by 117 publications

(90 citation statements)

References 20 publications

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“…6,7 Omphalopagus conjoined twins comprise 35% of all conjoined twins and are usually fused ventrally in the umbilical area, commonly involving the lower thorax but never involving the heart. 1,4 Liver fusion is found in approximately 80% of omphalopagus conjoined twins, with a common biliary tree in 20% of cases. 8 The stomachs and proximal small intestines are often separated, and the distal ileum and colon are shared in approximately one-third of cases, with separate rectums.…”

Section: Discussionmentioning

confidence: 99%

“…8 The stomachs and proximal small intestines are often separated, and the distal ileum and colon are shared in approximately one-third of cases, with separate rectums. 1,8,9 A careful investigation of the anatomy and blood supply in a shared liver is crucial before considering surgical separation. In our case, portal venous communication was found on dynamic CT.…”

Section: Discussionmentioning

confidence: 99%

“…1,4,5 Conjoined twins often exhibit multiple anomalies and organ sharing. Detailed preoperative imaging facilitates accurate study of the anatomy.…”

Section: -3mentioning

confidence: 99%

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Assessment of the Hepatic Vasculature in Omphalopagus Conjoined Twins Using Contrast-Enhanced Dynamic Computed Tomography

Kiryu¹

2017

IJRRT

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Eight-hour-old female symmetrical conjoined twins were transferred to our hospital to assess for surgical separation. Imaging modalities were used to assess the anatomy in detail. Contrast agent was administrated to one baby, and dynamic contrast-enhanced computed tomography (CT) was performed. The livers of the two twins were fused, and there was portal venous communication in the early phase. Crossover circulation was observed in the delayed phase. Most of the other organs were found to be independent according to CT, so separation was considered feasible. The surgical separation was carried out successfully.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of the Hepatic Vasculature in Omphalopagus Conjoined Twins Using Contrast-Enhanced Dynamic Computed Tomography

Kiryu¹

2017

IJRRT

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“…Cardiac defects, abnormal pulmonary and hepatic venous drainage, congenital diaphragmatic hernias, intestinal atresia, neural tube defects, cystic hygroma, urologic anomalies such as renal dysplasia and double collecting system, and orthopedic anomalies such as hip dislocation, club foot, vertical talus, and scoliosis can be seen in conjoined twins (10). Cerebrospinal anomalies such as dysgenesis of the corpus callosum, encephalocele, and syringomyelia have been reported in conjoined twins (4,11).…”

Section: Discussionmentioning

confidence: 99%

MR imaging of omphalopagus conjoined twins with a dandy-walker malformation: prenatal true FISP & HASTE sequences

Ünal

Arslan²,

Adalı³

et al. 2008

Diagn Interv Radiol

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Conjoined twins (formerly known as Siamese twins) are the result of a very rare congenital anomaly, the incidence of which is estimated to be around one per 250,000 live births (1). The classification is based on the most prominent site of anatomical connection. The anatomic location is followed by the designation "pagus", from the Greek word meaning something fixed or solid. Thoracopagus is the most common variety of these twins (2). Omphalopagus twins are the second most common variety, usually joined at the umbilical region (3). Pelvic bones are usually separate in this type. Although ultrasound (US) is widely used for the diagnosis of conjoined twins, magnetic resonance imaging (MRI) is the best modality to provide detailed imaging of fetuses with complex anomalies, especially in late pregnancy. Ultrafast imaging sequences have revolutionized fetal MRI, especially in neuroradiological examination (4). We present a case of omphalopagus conjoined twins with a Dandy-Walker malformation evaluated by ultrafast MRI sequences. Case reportA 26 year-old woman, gravida 2, para 1, at 24 weeks of gestation was referred to our radiology department with a diagnosis of conjoined twins. Her history was unremarkable. A pair of twins was diagnosed antenatally by fetal ultrasound, which revealed that they were joined at the abdomen and pelvis. A single posterior placenta with polyhydramnios was identified. A single artery and a single vein in the umbilical cord were noted on color Doppler sonography. At 24 and 32 weeks of gestation, MRI of the fetuses was performed using 1.5 T MRI system (Symphony, Siemens, Erlangen, Germany) with coronal and axial images that were obtained using T2-weighted fast imaging with steady-state procession (true FISP) and half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences to establish the diagnosis, and to better delineate the anatomic features.The study protocols were: TR/TE/flip angle/matrix/slice number/acquisition time, 81 ms/5.5 ms/80°/256x156/40/25/24 s for true FISP; and 1100 ms/120 ms/150°/256x156/40/44 s for HASTE.Conjoined twins were visualized successfully, and were observed to be joined from the abdomen to the pelvic area (Fig. 1). The liver was shared, and the pelvic bones were conjoined. The four legs were connected with the conjoined pelvis. Gallbladder drainage and hepatic venous drainage were separate. The fetuses had two separate chests, urinary tracts, and gastrointestinal tracts. Although polyhydramnios was visualized by the first MRI, at the second examination the amniotic fluid was diminished.In Fetus 1, the posterior fossa was filled with cerebrospinal fluid, as visualized on MRI examination. The cerebellum, vermis, and corpus callosum were not seen. The third and lateral ventricles were enlarged. The ABSTRACT Conjoined twins are an extremely rare congenital malformation without any known genetic predisposition. Omphalopagus twins are the second most common variety of conjoined twins and usually are joined at the umbilicus. We present omphalopagus conjoined ...

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“…New imaging techniques provide important anatomic details and help in planning the separation procedure [2,3]. Despite these technological advances, however, the complex arrangement of conjoined organs is somewhat difficult to interpret, leaving unresolved questions at time of surgery.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic laparoscopy and preoperative planning in ischiopagus tripus conjoined twins: a surgical first, with detailed demonstration of the complex anatomical relationships

et al. 2011

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Background Diagnosis and management of conjoined twins are constantly evolving [1]. New imaging techniques provide important anatomic details and help in planning the separation procedure [2,3]. Despite these technological advances, however, the complex arrangement of conjoined organs is somewhat difficult to interpret, leaving unresolved questions at time of surgery. The authors present a video demonstrating laparoscopy as an adjunct in the preoperative planning of separation of ischiopagus tripus conjoined twins as well as illustrating the complex anatomy in a combination of video, drawings, and radiologic imaging. To date, this is the first time that laparoscopy has been used in preoperative assessment of conjoined twins. Methods After elective cesarean delivery, ischiopagus tripus conjoined twins were thoroughly evaluated with conventional imaging, including plain radiographs and computed tomography scan with three-dimensional (3-D) reconstruction images. The anatomy of the gastrointestinal and genitourinary tracts was further defined with barium enema, retrograde pyelography, and cystoscopy. In addition to these tests, diagnostic laparoscopy was performed at time of tissue expander placement. An angled scope, introduced through a 5-mm umbilical port, was used to visualize the intraperitoneal organs as well as all accessible retroperitoneal structures. Results Laparoscopy provided useful information regarding the bowel distribution between the twins. In addition, it helped demonstrate the relationship of shared solid organs with other intra-abdominal structures and identify anatomic landmarks used in the subsequent separation of the twins. Finally, laparoscopy helped confirm the presence, number, and morphology of the internal female genitalia. Conclusions Diagnostic laparoscopy is a useful tool in evaluation of ischiopagus tripus conjoined twins. It is an important adjunct to preoperative studies in preparing for an expeditious and safe separation procedure.

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Imaging in the Preoperative Assessment of Conjoined Twins

Cited by 117 publications

References 20 publications

Assessment of the Hepatic Vasculature in Omphalopagus Conjoined Twins Using Contrast-Enhanced Dynamic Computed Tomography

Assessment of the Hepatic Vasculature in Omphalopagus Conjoined Twins Using Contrast-Enhanced Dynamic Computed Tomography

MR imaging of omphalopagus conjoined twins with a dandy-walker malformation: prenatal true FISP & HASTE sequences

Diagnostic laparoscopy and preoperative planning in ischiopagus tripus conjoined twins: a surgical first, with detailed demonstration of the complex anatomical relationships

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