Background: Feto-fetal transfusion (FFTS) may be associated with cerebral injury. This study characterized the cerebral magnetic resonance imaging (MRI) changes seen in survivors of severe mid-trimester FFTS. Subjects: The 13 surviving infants (8 male;5 female) from eight twin pregnancies complicated by FFTS, born at median (range) gestational age of 29(25-35) weeks and studied at four (0-26) weeks postnatal age. Intervention: MRI examination using TI, inversion recovery and T2 weighted sequences on a 1.0 Tesla Picker HPQ system. Results: All infants had MRI abnormalities including: ventricular dilatation (10); basal ganglia damage (7); abnormal white matter signal (3); haemorrhagic infarction(1) and occipital haemorrhage(1). Conclusion: Both donor and recipient twins demonstrated a variety of cerebral lesions on MRI.