title: Neuro-imaging findings in infants with congenital cytomegalovirus infection: relation to trimester of infection.
abstract: BACKGROUND
  Congenital cytomegalovirus (cCMV) infection early in pregnancy may result in major disabilities. Cerebral abnormalities detected using cranial ultrasound (cUS) and magnetic resonance imaging (MRI) have been related to neurological sequelae.
  
  
  OBJECTIVE
  To evaluate the additional value of MRI and assess the relationship between time of infection during pregnancy and outcome in infants with cCMV infection.
  
  
  METHODS
  Demographic and clinical data were collected in infants with cCMV infection (1992-2013). Trimester of infection, neuro-imaging results and outcome were reviewed. Cerebral abnormalities were categorized into none, mild (lenticulostriate vasculopathy, germinolytic cysts, high signal intensity on T2-weighted images) and severe (migrational disorder, ventriculomegaly, cerebellar hypoplasia). Results were statistically analysed.
  
  
  RESULTS
  Thirty-six infants were eligible for analysis. cUS was performed in all and cranial MRI in 20 infants. Migrational disorders were only diagnosed using MRI (p < 0.01). In 17 infants trimester of infection was ascertained. Seven out of 10 infants infected during the first trimester had severe abnormalities on cUS (5 confirmed on MRI) and adverse sequelae; 3 had no/mild abnormalities on cUS/MRI and normal outcome. Two out of 3 infants infected during the second trimester with no/mild abnormalities on cUS/MRI had normal outcome; 1 with mild cUS and MRI abnormalities developed sensorineural hearing loss. Four infants infected during the third trimester with no/mild abnormalities on cUS/MRI had normal outcome.
  
  
  CONCLUSIONS
  Infants with a first trimester cCMV infection are most at risk of severe cerebral abnormalities and neurological sequelae. MRI, and not cUS, enables an early diagnosis of migrational disorders, which can improve prediction of outcome.
authors: Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors: Natanja
authors: N
authors: Oosterom
authors: Joppe
authors: J
authors: Nijman
authors: Julia
authors: J
authors: Gunkel
authors: Tom F W
authors: TF
authors: Wolfs
authors: Floris
authors: F
authors: Groenendaal
authors: Malgosia A
authors: MA
authors: Verboon-Maciolek
authors: Linda S
authors: LS
authors: de Vries
mesh_terms: D001927:Brain Diseases / Q000151:congenital* / Q000175:diagnosis*; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000151:congenital* / Q000175:diagnosis*; D004453:Echoencephalography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008279:Magnetic Resonance Imaging; D008297:Male; D009426:Netherlands; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011256:Pregnancy Outcome; D011264:Pregnancy Trimesters