National and Kapodistrian University of Athens, Third Department of Paediatrics, Attikon General University Hospital, Athens, Greece.
Department of Radiology Medical School, University of Ioannina, Ioannina, Greece.
J Matern Fetal Neonatal Med. 2023 Dec;36(1):2220564. doi: 10.1080/14767058.2023.2220564.
Congenital CMV infection (cCMV) is the most common congenital infection with 10-15% of cases developing symptomatic disease. Early antiviral treatment is of essence when symptomatic disease is suspected. Recently, the use of neonatal imaging has been implicated as a prognostic tool for long term sequalae among asymptomatic newborns at high risk. Even though neonatal MRI is commonly used in neonatal symptomatic cCMV disease, it is less often used in asymptomatic newborns, mainly due to cost, access and difficulty to perform. We have therefore developed an interest in assessing the use of fetal imaging as an alternative. Our primary aim was to compare the fetal and neonatal MRIs in a small cohort 10 asymptomatic neonates with congenital CMV infection.
We performed a single-center retrospective cohort study (case-series) on a convenience sample of children born from January 2014 to March 2021 with confirmed congenital CMV infection who had undergone both fetal and neonatal MRIs. We created a checklist of relevant cerebral abnormalities and asked 4 blinded radiologists to assess the MRIs (2 for each, namely fetal and neonatal) and then compared the findings between the fetal and neonatal imaging as well as the concordance in reporting of abnormalities within each category.
Overall concordance between prenatal and postnatal scans was high (70%). When comparing the two blinded reports for each MRI, we found high levels of concordance: 90% concordance for fetal MRIs and 100% for neonatal MRIs. The most common abnormalities identified in both fetal and neonatal scans were "abnormal white matter hyperintensity" and "subependymal cysts."
Even though this is a small descriptive study, it indicates that fetal MRI could potentially provide us with similar information as neonatal imaging. This study could form the basis for subsequent larger future studies.
先天性巨细胞病毒感染（cCMV）是最常见的先天性感染，其中 10-15%的病例会出现症状性疾病。当怀疑出现症状性疾病时，早期抗病毒治疗至关重要。最近，新生儿影像学的应用已被认为是高风险无症状新生儿长期后遗症的预后工具。尽管新生儿 MRI 常用于新生儿症状性 cCMV 疾病，但在无症状新生儿中使用较少，主要是由于成本、获取途径和实施难度。因此，我们对评估胎儿影像学的应用产生了兴趣。我们的主要目的是在一个 10 名无症状先天性巨细胞病毒感染新生儿的小队列中比较胎儿和新生儿 MRI。
我们对 2014 年 1 月至 2021 年 3 月间出生的确诊为先天性巨细胞病毒感染且均行胎儿和新生儿 MRI 的方便样本进行了单中心回顾性队列研究（病例系列）。我们创建了一个与脑异常相关的检查表，并要求 4 名盲法放射科医生评估 MRI（每个 MRI 各 2 名），然后比较胎儿和新生儿影像学之间的发现以及每个类别中异常报告的一致性。
产前和产后扫描之间的总体一致性很高（70%）。当比较每例 MRI 的两份盲法报告时，我们发现高度一致性：胎儿 MRI 为 90%，新生儿 MRI 为 100%。在胎儿和新生儿扫描中均发现的最常见异常为“异常脑白质高信号”和“室管膜下囊肿”。
尽管这是一项小型描述性研究，但它表明胎儿 MRI 可能可以为我们提供与新生儿影像学相似的信息。本研究可以为随后的更大规模的未来研究奠定基础。
