OC08.05: Are serial <scp>MRIs</scp> of any value in the assessment of cerebral ischemic injury following co‐twin demise?
Bibliographic record
Abstract
Hypotensive ischemic injury may result in transient changes on intrauterine magnetic resonance imaging (MRI) in monochorionic (MC) pregnancies. Our aim was to evaluate the use of serial MRIs in the evaluation of ischemic injury following co-twin demise. We reviewed all MC pregnancies who had more than one MRI (diffusion-weighted and T2) with co-twin demise at our tertiary care centre. Pregnancy demographics, ultrasound and MRI findings and obstetric outcomes were collected between 2005 and 2015. A total of 15 MC pregnancies had co-twin demise and serial MRIs, including 13 MC/diamniotic (DA) twins, 1 monoamniotic (MA) and 1 triplet with an MC/DA pair were reviewed. Six cases were complicated by Twin–twin transfusion syndrome (TTTS), 5 of which demised before treatment and 1 post-laser ablation of placental anastomoses, 6 had selective intrauterine growth restriction (sIUGR), 1 was MA and 2 had an unexplained intrauterine fetal death (IUFD). The vast majority of MRIs (14/15) were done within 7 days following IUFD. Of these, 3 had normal MRIs which remained normal on subsequent MRI and one was initially normal (done one day after IUFD), but subsequently showed extensive white matter injury. Eleven cases had abnormal MRI findings, of which four lesions significantly evolved (left occipital infarct resolved, multifocal small infarcts revolved, thick germinal matrix normalised and cerebellar bleed decreased in size) and the remainder seven cases had similar lesions on subsequent MRI. An initial MRI, especially if done within 7 days after co-twin demise in MC pregnancies, should warrant a subsequent MRI to evaluate the evolution of ischemic changes and help in the counselling of couples.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".