title: Region-specific reductions in brain apparent diffusion coefficient in cytomegalovirus-infected fetuses.
abstract: OBJECTIVE
  To evaluate the effects of cytomegalovirus (CMV) infection on apparent diffusion coefficient (ADC) values of the fetal brain in utero.
  
  
  METHODS
  In this retrospective analysis we compared 58 fetal head magnetic resonance imaging (fhMRI) scans of PCR-verified CMV-infected fetuses, obtained in 2008-2012, with those of a normal control group of 36 gestational age (GA)-matched uninfected fetuses scanned between 2006 and 2012. Estimated GA at infection ranged from 1 to 32 weeks, and fhMRI was performed at 24 to 38 weeks. The frontal, parietal, temporal and occipital lobes (mainly white matter), basal ganglia, thalamus, pons and cerebellum were analyzed by assessing ADC values. Two pregnancies were terminated and postmortem confirmation was available in these cases.
  
  
  RESULTS
  ADC values of CMV-infected fetuses correlated significantly and negatively with GA in all brain regions except the basal ganglia. The cerebellum had the greatest reduction (r = -0.52, P < 0.0001). Maternal age correlated positively with ADC in the frontal lobe (P < 0.05). GA at infection and overt pathological changes did not affect ADC significantly. Compared with non-infected fetuses, ADC values of affected fetuses were significantly reduced in the frontal (P < 0.0001), parietal (P < 0.0001), occipital (P = 0.0005) and temporal (P = 0.001) lobes and thalamus (P = 0.006).
  
  
  CONCLUSIONS
  CMV infection of the fetal brain results in a highly significant, region-dependent reduction of ADC values in the frontal, parietal, occipital and temporal lobes and thalamus, probably reflecting hypercellularity and inclusion bodies in damaged areas. Further studies are needed to determine if reduction in ADC values may serve as a prognostic factor in CMV-infected fetuses. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel.|Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Israel and the Israeli Defence Force Medical Corps.
authors.forename: G
authors.initials: G
authors.lastname: Yaniv
authors.affiliation: Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: C
authors.initials: C
authors.lastname: Hoffmann
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel.
authors.forename: B
authors.initials: B
authors.lastname: Weisz
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Lipitz
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Katorza
authors.affiliation: Department of Pathology, Meir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Kidron
authors.affiliation: Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Bergman
authors.affiliation: Department of Neurology, Stony Brook University School of Medicine, Stony Brook, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Biegon
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000196:embryology / Q000821:virology; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000000981:diagnostic imaging*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D012189:Retrospective Studies
keywords: ADC; CMV; DWI; apparent diffusion coefficient; brain; cytomegalovirus; diffusion weighted imaging; fetal head magnetic resonance imaging; fhMRI