The use of fetal neurosonography and brain <scp>MRI</scp> in cases of cytomegalovirus infection during pregnancy: A retrospective analysis with outcome correlation

Birnbaum, R.; Ben-Sira, Liat; Lerman‐Sagie, Tally; Malinger, G.

doi:10.1002/pd.5180

Cited by 34 publications

(51 citation statements)

References 29 publications

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“…From the existing literature, it is quite clear that CMV affected fetuses and newborns with signs of CNS involvement are at an increased risk of presenting with CMV related symptomatology. On the other hand, our group and others have shown that the absence of signs of CNS involvement during fetal life or after birth in the presence of CMV infection are almost invariably associated with a normal developmental outcome, with a residual risk of hearing deficits of approximately 5%. The objective of the present study was to assess the significance of different subtle CNS imaging findings considered to be associated with CMV but for which the prognosis is still controversial.…”

Section: Discussionmentioning

confidence: 85%

“…In our previous study, we found five infected fetuses with isolated LSV on US and normal MRI. All these newborns were asymptomatic and developing normally . Benoist et al found normal development in eight infected newborns with isolated LSV on brain US .…”

Section: Discussionmentioning

confidence: 90%

“…The cohort included patients with subtle and clinically inconclusive findings on either US or MRI (Table and Figure ). As a result of the clinical uncertainty, we informed our patients that the expected prognosis is likely to be favorable as the findings are mild and subtle and do not progress through gestation or involve fetal growth restriction …”

Section: Methodsmentioning

confidence: 85%

“…However, the clinical significance of isolated or subtle abnormalities on postnatal imaging is not well established . It is well established that when a dedicated fetal ultrasound (US) exam in a CMV infected fetus is normal, the neurodevelopmental outcome will be normal in the vast majority of cases . When subtle findings are detected on prenatal imaging (MRI and/or US), the clinical significance still remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…As mentioned in other sections, fetal MRI is expanding its diagnostic role, particularly in the brain. This includes assessment of brain effects from anomalies in other organs, such as the heart, and of congenital infections …”

Section: Diagnosis Of Fetal Brain Anomalies By Mrimentioning

confidence: 99%

In case you missed it: The Prenatal Diagnosis editors bring you the most significant advances of 2017

et al. 2018

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Brain Metabolite Differences in Fetuses With Cytomegalovirus Infection: A Magnetic Resonance Spectroscopy Study

Sadan,

Avisdris,

Rabinowich

et al. 2024

Magnetic Resonance Imaging

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BackgroundCytomegalovirus (CMV) is the most common intrauterine infection and may be associated with unfavorable outcomes. While some CMV‐infected fetuses may show gross or subtle brain abnormalities on MRI, their clinical significance may be unclear. Conversely, normal development cannot be guaranteed in CMV‐infected fetuses with normal MRI.PurposeTo assess brain metabolite differences in CMV‐infected fetuses using magnetic resonance spectroscopy (MRS).Study typeRetrospective.SubjectsOut of a cohort of 149 cases, 44 with maternal CMV infection, amniocentesis results, and good‐quality MRS were included. CMV‐infected fetuses with positive polymerase chain reaction (PCR) (N = 35) were divided based on MRI results as follows: typical brain abnormalities (gross findings, N = 8), exclusive white matter hyperintense signal (WMHS) on T2‐weighted images (subtle findings, N = 7), and normal MRI (N = 20). Uninfected fetuses (negative PCR) with normal MRI were included as controls (N = 9).Field Strength3 T, T2‐weighted half Fourier single‐shot turbo spin‐echo (HASTE), T2‐weighted true fast imaging with steady‐state free precession (TrueFISP), T1‐ and T2*‐weighted fast low angle shot (FLASH), and 1H‐MRS single‐voxel point resolved spectroscopy (PRESS) sequences.AssessmentMRI findings were assessed by three radiologists, and metabolic ratios within the basal ganglia were calculated using LCModel.Statistical TestsAnalysis of covariance test with Bonferroni correction for multiple comparisons was used to compare metabolic ratios between groups while accounting for gestational age. A P‐value <0.05 was deemed significant.ResultsMRS was successfully acquired in 63% of fetuses. Substantial agreement was observed between radiologists (Fleiss' kappa [k] = 0.8). Infected fetuses with gross MRI findings exhibited significantly reduced tNAA/tCr ratios (0.64 ± 0.08) compared with infected fetuses with subtle MRI findings (0.85 ± 0.19), infected fetuses with normal MRI (0.8 ± 0.14) and controls (0.81 ± 0.15). No other significant differences were detected (P ≥ 0.261).ConclusionReduced tNAA/tCr within the apparently normal brain tissue was detected in CMV‐infected fetuses with gross brain abnormalities, suggesting extensive brain damage. In CMV‐infected fetuses with isolated WMHS, no damage was detected by MRS.Level of Evidence3Technical EfficacyStage 3

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The use of fetal neurosonography and brain MRI in cases of cytomegalovirus infection during pregnancy: A retrospective analysis with outcome correlation

Abstract: Adding MRI in CMV-infected cases with a normal neurosonographic follow-up should be weighed against a nonnegligible rate of false positive and inconclusive findings.

Cited by 34 publications

References 29 publications

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

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

In case you missed it: The Prenatal Diagnosis editors bring you the most significant advances of 2017

Brain Metabolite Differences in Fetuses With Cytomegalovirus Infection: A Magnetic Resonance Spectroscopy Study

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