title: A Prognostic Neonatal Neuroimaging Scale for Symptomatic Congenital Cytomegalovirus Infection.
abstract: Congenital cytomegalovirus (cCMV) can cause brain inflammation/destruction and teratogenic effects. The only validated neuroimaging prognostic categorization for symptomatic cCMV available is based on destructive lesions seen on computed tomography (CT).
  
  
  
  The aim of this study was to establish the predictive ability of a comprehensive neonatal neuroimaging scale in symptomatic cCMV.
  
  
  
  Twenty-six infants were studied by neonatal cranial ultrasound scans (US; n = 25), CT (n = 11) and magnetic resonance imaging (MRI; n = 9). A previously validated neuroimaging scale comprising calcifications, ventriculomegaly and atrophy was compared to a newly proposed system adding cerebral dysgenesis and white matter disease. The findings were graded from 0 to 3. Neurodevelopmental assessment included motor and cognitive functions, epilepsy, vision, hearing and behavioral disorders.
  
  
  
  Both scales showed a significant association with outcome (p < 0.005). Our scale was more accurate in predicting death or moderate-severe disability (area under the curve for scores ≥2, 0.88 ± 0.06 vs. 0.80 ± 0.08). All 5 infants with normal neuroimaging survived with intact neurological function. While our scale was highly associated with outcome in patients studied by MRI, it was unable to predict unfavorable outcomes in 2 patients with mildly abnormal US and/or CT.
  
  
  
  A comprehensive scale based on US and MRI predicts neurodevelopment in symptomatic cCMV. Significant destructive lesions are associated with a poor prognosis. While a strictly normal cranial US predicts a favorable outcome, in case of subtle US abnormalities, MRI is crucial for prognostication.
authors.affiliation: Neonatal Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: Ana
authors.initials: A
authors.lastname: Alarcon
authors.forename: Miriam
authors.initials: M
authors.lastname: Martinez-Biarge
authors.forename: Fernando
authors.initials: F
authors.lastname: Cabañas
authors.forename: Jose
authors.initials: J
authors.lastname: Quero
authors.forename: Alfredo
authors.initials: A
authors.lastname: García-Alix
mesh_terms: D020144:Basal Ganglia Cerebrovascular Disease / Q000000981:diagnostic imaging; D002547:Cerebral Palsy / Q000000981:diagnostic imaging; D003071:Cognition; D003586:Cytomegalovirus Infections / Q000151:congenital* / Q000000981:diagnostic imaging*; D002658:Developmental Disabilities / Q000175:diagnosis*; D004453:Echoencephalography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000000981:diagnostic imaging; D059906:Neuroimaging; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013030:Spain; D014057:Tomography, X-Ray Computed; D066127:White Matter / Q000473:pathology*