Subtle findings on fetal brain imaging in CMV infected pregnancies: What is the clinical significance? A retrospective analysis with outcome correlation

Abstract

Objective To describe the prognosis of subtle findings on fetal brain imaging in pregnant women with primary CMV infection during pregnancy. Methods This was a retrospective study. The data included: timing of infection, amniocentesis results, imaging findings, obstetric outcome, and developmental assessment. Results For the 27 included patients, the time of infection was: periconception, first, second, third trimesters or unknown in 14.8%, 29.7%, 40.7%, 7.4%, and 7.4%, respectively. Seventy‐four percent had only MRI findings; white matter hyperintense T2 signal (HT2) (51.8%), mild ventriculomegaly (18.5%), HT2 and temporal cyst (7.4%), dilated occipital horn (7.4%), Periventricular pseudo cyst (PVPC) with dilated occipital horn (3.7%), isolated PVPC (7.4%), choroid plexus cyst (3.7%). In 26% of fetuses, additional ultrasound findings were observed: Lenticulostriatal vasculopathy (LSV) (11.1%), LSV with PVPC (3.84%), isolated PVPC (3.84%), mild ventriculomegaly (3.84%), and bilateral temporal cysts (3.84%). In 66.6%, the MRI had false‐positive findings (due to noninfected neonates). All children are developing normally, and one has a hearing deficit. Postnatal ultrasound (US) was normal in 21/27, with LSV in five, and a resolving subependymal cyst in one patient. Conclusion Subtle imaging findings are more common on MRI than US and the prognosis is most likely favorable. Performing amniocentesis will significantly reduce the false‐positive rate.

A unique brain germinal matrix involvement in cytomegalovirus infected fetuses: A retrospective neurosonographic analysis with outcome correlation

“…11 On the other hand, isolated hyperintense T2 white matter signal on the MRI has been previously described both by us and others to carry good prognosis. 6,8,11 In the current study, we further support this observation, as we show that when HCGM is an isolated brain finding on neurosonography, regardless to the presence of an accompanying LSV, the observation of hyperintense T2 white matter signal on MRI, most probably carry favorable prognosis.…”

“…In our previous publication, we searched part of this database for various subtle brain ultrasound (US) findings, excluding those that comprise the current cohort. 6 The study was approved by the Tel Aviv Sourasky Medical Center's Ethics Board. In Israel, although not obligatory, it is a common practice to screen for CMV serology during the first trimester.…”

“…The collected data included timing of seroconversion: periconceptional (an infection presumed to be 1 week before to 5 weeks following conception, according to anti-CMV IgG avidity results), 3 first, second, or third trimester; amniocentesis results; US and MRI findings; obstetric and neonatal outcome; and developmental followup. For developmental assessment we used a telephone questionnaire as described previously, 6 after informed consent was obtained. In group B, all four patients were diagnosed with multiple brain findings in addition to the presence of an HCGM (Table 2, Figure 2).…”

“…This is a retrospective analysis of our database of patients referred to the Obstetric Ultrasound Unit during 2015–2019, due to primary maternal CMV infection. In our previous publication, we searched part of this database for various subtle brain ultrasound (US) findings, excluding those that comprise the current cohort 6 . The study was approved by the Tel Aviv Sourasky Medical Center's Ethics Board.…”

“…Nevertheless, the clinical significance of isolated and subtle findings diagnosed in the fetus still remains uncertain 3 ,. 5 We recently published our results in a group of fetuses with various subtle brain findings diagnosed on neurosonography (NSG) in CMV infected patients, showing normal outcome and a 3.7% rate of hearing deficits 6 . Despite these preliminary results, further prognostic studies focused on specific subtle findings are needed, especially in countries where late termination of pregnancy (TOP) is an option.…”