Utilization of magnetic resonance imaging in autopsy planning with specimen preservation for thoraco‐omphalopagus symmetricus conjoined twins

Abstract

Conjoined twinning is a rare obstetric event that has fascinated physicians and laypersons alike for centuries. When this event occurs, early diagnosis, close prenatal management, and the proper route of delivery will assure the best possible outcome for mother and affected infants. Magnetic resonance imaging (MRI) is used both as an ancillary technique to the sonography for the antepartum diagnosis and in the preoperative planning for the surgical separation of conjoined twins. This report describes the MRI findings in conjoined twins of the thoraco-omphalopagus symmetricus type, a condition incompatible with extrauterine life. The twins were delivered at 21 weeks gestation. The MRI was used to evaluate the anatomic nature of the internal anomalies. These findings were then used to develop an autopsy approach plan that preserved the external phenotype. After dissection, the specimen was preserved by using polyethylene glycol and ultimately prepared for use as a teaching specimen.

Virtopsy in conjoined ischiopagus twins

“…In cases of fetal demise, postmortem CT and MRI are able to realize a sort of virtual autopsy, so-called "virtopsy". It may represent an option to disclose fetal anatomy if the couple refuses to authorize the necropsy or may be useful in autopsy planning with specimen preservation [10][11][12].…”