The fusion of anatomic and functional imaging in preoperative evaluation of thoracoabdominalpagus conjoined twins

Conjoined twins is an extremely rare congenital abnormality. Preoperative evaluation of anatomy and functional of conjoined twins is very important in order to devise appropriate surgical strategies for separation. Preoperative evaluation of thoracoabdominalpagus female twins was performed after intravenous injection of 37 MBq Te-99m EHIDA in twin A. Dynamic images, static images and SPECT/CT fused images were obtained by gamma camera-mounted anatomical X-ray tomography (Millenium VG with Hawkeye). After 3 days, the same procedure was repeated for twin B. Cholescintigraphy demonstrated two independent and potentially separable hepatobiliary systems in both twins. The gallbladder and common bile duct were visualized in both twins and there was excretion in to the intestine. Fusion of morphology and function were in keeping with radiographic, operative, and clinical findings. The conjoined twins were separated successfully and alive with normal liver function. SPECT/CT fused images provide additional information that improves diagnostic accuracy and impacts on patient management. (authors)