Oosterom Natanja, Nijman Joppe, Gunkel Julia, Wolfs Tom F W, Groenendaal Floris, Verboon-Maciolek Malgosia A, de Vries Linda S
Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Neonatology. 2015;107(4):289-96. doi: 10.1159/000375439. Epub 2015 Mar 10.
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.
To evaluate the additional value of MRI and assess the relationship between time of infection during pregnancy and outcome in infants with cCMV infection.
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.
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.
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.
孕期早期先天性巨细胞病毒（cCMV）感染可能导致严重残疾。使用头颅超声（cUS）和磁共振成像（MRI）检测到的脑部异常与神经后遗症有关。
评估MRI的附加价值，并评估孕期感染时间与cCMV感染婴儿结局之间的关系。
收集1992年至2013年期间cCMV感染婴儿的人口统计学和临床数据。回顾感染孕周、神经影像学结果和结局。脑部异常分为无、轻度（豆纹状血管病变、生发层囊肿、T2加权图像上高信号强度）和重度（移行障碍、脑室扩大、小脑发育不全）。对结果进行统计学分析。
36名婴儿符合分析条件。所有婴儿均进行了cUS检查，20名婴儿进行了头颅MRI检查。仅通过MRI诊断出移行障碍（p<0.01）。确定了17名婴儿的感染孕周。在孕早期感染的10名婴儿中，7名在cUS上有严重异常（5名经MRI证实）并有不良后遗症；3名在cUS/MRI上无/有轻度异常且结局正常。在孕中期感染的3名婴儿中，2名在cUS/MRI上无/有轻度异常，结局正常；1名cUS和MRI有轻度异常的婴儿出现感音神经性听力损失。在孕晚期感染的4名婴儿中，cUS/MRI无/有轻度异常，结局正常。
孕早期cCMV感染的婴儿发生严重脑部异常和神经后遗症的风险最高。MRI而非cUS能够早期诊断移行障碍，这可以改善结局预测。
