Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan,
Neonatology. 2020;117(4):460-466. doi: 10.1159/000508218. Epub 2020 Jun 3.
Congenital cytomegalovirus infection (CCMVI) may result in neurodevelopmental impairments (NDIs) such as hearing loss, developmental delay, epilepsy, and cerebral palsy. We aimed to investigate the potential for brain magnetic resonance imaging (MRI) to predict NDI in patients with CCMVI.
We studied infants with CCMVI who were referred to our hospital from April 2010 to October 2018 and underwent a brain MRI within 3 months since birth. We screened for 6 classic presentations of CCMVI including ventriculomegaly, periventricular cysts, hippocampal dysplasia, cerebellar hypoplasia, migration disorders, and white matter abnormalities. Images were interpreted by a blinded pediatric radiologist. NDI was defined as having a developmental quotient <80, hearing dysfunction, blindness, or epilepsy requiring anti-epileptic drugs at approximately 18 months of corrected age.
The study involved 42 infants with CCMVI (median gestational age 38 weeks, birthweight 2,516 g). At least one abnormal finding was detected in 28 (67%) infants. Abnormal findings consisted of 3 cerebellar hypoplasia (7%), 7 migration disorders (17%), 26 white matter abnormalities (62%), 12 periventricular cysts (28%), 1 hippocampal dysplasia (2%), and 20 ventriculomegaly (48%). Abnormal findings were significantly more prevalent in infants with clinical symptoms (21/24, 91%) than in those without (7/19, 37%, p < 0.01). For NDI prediction, having ≥2 of ventriculomegaly, periventricular cysts, and white matter abnormality produced the highest Youden index values (0.78).
Infants with CCMVI with at least 2 of the abovementioned specific brain image abnormalities may be at high risk of developing NDI.
先天性巨细胞病毒感染（CCMVl）可能导致神经发育障碍（NDIs），如听力损失、发育迟缓、癫痫和脑瘫。我们旨在研究脑磁共振成像（MRI）在预测 CCMVl 患者 NDI 方面的潜力。
我们研究了 2010 年 4 月至 2018 年 10 月期间因 CCMVl 被转诊到我院的婴儿，并在出生后 3 个月内进行了脑 MRI。我们筛查了包括脑室扩大、室周囊肿、海马发育不良、小脑发育不全、移行障碍和白质异常在内的 6 种 CCMVl 经典表现。图像由一名盲法儿科放射科医生进行解读。NDl 定义为发育商<80、听力障碍、失明或癫痫，需要在大约 18 个月的校正年龄时使用抗癫痫药物。
该研究共纳入 42 例 CCMVl 婴儿（中位胎龄 38 周，出生体重 2516g）。28 例（67%）婴儿至少发现 1 种异常。异常表现包括 3 例小脑发育不全（7%）、7 例移行障碍（17%）、26 例白质异常（62%）、12 例室周囊肿（28%）、1 例海马发育不良（2%）和 20 例脑室扩大（48%）。有临床症状的婴儿（24 例中有 21 例，91%）异常表现明显多于无症状婴儿（19 例中有 7 例，37%，p<0.01）。对于 NDI 预测，脑室扩大、室周囊肿和白质异常≥2 项具有最高的 Youden 指数值（0.78）。
至少存在上述 3 种特定脑图像异常的 CCMVl 婴儿可能有发生 NDI 的高风险。
