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Eley KA, Rossi-Espagnet MC, Schievano S, Napolitano A, Ong J, Secinaro A, Borro L, Dunaway D, Marras CE, Rennie A, Robertson F, Picardo S, Longo D, Inserra A, Rollo M, Cooper J, Mankad K, Jeelani NO, D'Arco F. Multiparametric Imaging for Presurgical Planning of Craniopagus Twins: The Experience of Two Tertiary Pediatric Hospitals with Six Sets of Twins. Radiology 2020; 298:18-27. [PMID: 33141005 DOI: 10.1148/radiol.2020202216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Conjoined twins are rare and pose a challenge to radiologists and surgeons. Craniopagus twins, where conjunction involves the cranium, are especially rare. Even in large pediatric centers, radiologists are unlikely to encounter more than one such event in their medical careers. This rarity makes it daunting to select a CT and MRI protocol for these infants. Using the experience of two tertiary pediatric hospitals with six sets of craniopagus twins, this multidisciplinary and multimodal integrated imaging approach highlights the key questions that need addressing in the decision-making process for possible surgical intervention.
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Affiliation(s)
- Karen A Eley
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Maria Camilla Rossi-Espagnet
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Silvia Schievano
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Antonio Napolitano
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Juling Ong
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Aurelio Secinaro
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Luca Borro
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - David Dunaway
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Carlo Efisio Marras
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Adam Rennie
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Fergus Robertson
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Sergio Picardo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Daniela Longo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Alessandro Inserra
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Massimo Rollo
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Jessica Cooper
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Kshitij Mankad
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Noor-Owase Jeelani
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
| | - Felice D'Arco
- From the Department of Neuroradiology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, England (K.A.E., A.R., F.R., J.C., K.M., F.D.); Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, England (K.A.E.); Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy (M.C.R.E., D.L., M.R.); Neuroscienze Salute Mentale e Organi di Senso Department, Sapienza University, Rome, Italy (M.C.R.E.); Department of Craniofacial Surgery, Great Ormond Street Hospital, London, England (S.S., J.O., D.D., N.O.J.); Advanced Cardiovascular Imaging Unit (A.S., L.B.), Department of General and Thoracic Surgery (A.I.), Medical Physics Department (A.N.), Neurosurgery Unit (C.E.M.), Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù, Rome, Italy (S.P.)
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