孤立性脑白质异常对先天性巨细胞病毒感染新生儿 MRI 的影响：一项前瞻性单中心研究。

Implications of isolated white matter abnormalities on neonatal MRI in congenital CMV infection: a prospective single-centre study.

机构信息

Department of Radiology and Nuclear Medicine, Universitair Ziekenhuis Gent, Gent, Belgium

Department of Neonatology, Universitair Ziekenhuis Gent, Gent, Belgium.

出版信息

BMJ Paediatr Open. 2023 Oct;7(1). doi: 10.1136/bmjpo-2023-002097.

OBJECTIVE

Investigating the clinical implications of isolated white matter abnormalities on neonatal brain MRI in congenital cytomegalovirus (CMV).

DESIGN

Prospective, observational.

PATIENTS/INTERVENTIONS: Two paediatric radiologists, blinded to clinical data, independently scored the white matter in 286 newborns with congenital CMV. After assessing interobserver variability, mean score was used to categorise white matter (normal, doubtful or abnormal). Patients with other brain abnormalities were excluded.

MAIN OUTCOME MEASURES

Hearing and neuromotor evaluation.

RESULTS

Cohen's weighted kappa was 0.79 (95% CI 0.73 to 0.84). White matter was normal in 121 patients, doubtful in 62, abnormal in 28. Median clinical follow-up was 12.0 months (IQR 12.0-27.7 months). Neonatal hearing loss occurred in 4/27 patients (14.8%) with abnormal, 1/118 patients (0.8%) with normal and 1/62 patients (1.6%) with doubtful white matter (p<0.01). Impaired cognitive development was seen in 3/27 patients (11.1%) with abnormal, 3/114 patients (2.6%) with normal and 1/59 patients (1.7%) with doubtful white matter (p=0.104). Alberta Infant Motor Scale (AIMS) was below P75 in 21/26 patients (80.8%) with abnormal, 73/114 patients (64.0%) with normal and 36/57 patients (63.2%) with doubtful white matter (p=0.231). In a subgroup of patients with minimal clinical follow-up of 18 months, AIMS score was below P75 in 10/13 patients (76.9%) with abnormal, 13/34 patients (38.2%) with normal and 7/20 patients (35.0%) with doubtful white matter (p<0.05).

CONCLUSIONS

Abnormal white matter was associated with neonatal hearing loss and mild, lower motor scores. A tendency towards impaired cognitive development was seen. Patients with doubtful white matter did not show worse clinical outcome.

目的

研究先天性巨细胞病毒（cytomegalovirus，CMV）新生儿脑 MRI 孤立性脑白质异常的临床意义。

设计

前瞻性、观察性研究。

患者/干预措施：两位儿科放射科医生，对临床数据不知情，对 286 例先天性 CMV 新生儿的脑白质进行独立评分。在评估了观察者间的变异性后，使用平均评分对白质（正常、可疑或异常）进行分类。排除了有其他脑异常的患者。

主要观察指标

听力和神经运动评估。

结果

Cohen's 加权kappa 为 0.79（95%可信区间 0.73 至 0.84）。121 例患者的脑白质正常，62 例可疑，28 例异常。中位临床随访时间为 12.0 个月（IQR 12.0-27.7 个月）。27 例异常脑白质患者中有 4 例（14.8%）出现新生儿听力损失，118 例正常脑白质患者中有 1 例（0.8%），62 例可疑脑白质患者中有 1 例（1.6%）（p<0.01）。27 例异常脑白质患者中，认知发育受损 3 例（11.1%），114 例正常脑白质患者中，认知发育受损 3 例（2.6%），59 例可疑脑白质患者中，认知发育受损 1 例（1.7%）（p=0.104）。26 例异常脑白质患者中，21 例（80.8%） Alberta 婴儿运动量表（Alberta Infant Motor Scale，AIMS）评分低于 P75，114 例正常脑白质患者中，73 例（64.0%）评分低于 P75，57 例可疑脑白质患者中，36 例（63.2%）评分低于 P75（p=0.231）。在随访时间至少 18 个月的患者亚组中，13 例异常脑白质患者中有 10 例（76.9%）AIMS 评分低于 P75，34 例正常脑白质患者中有 13 例（38.2%），20 例可疑脑白质患者中有 7 例（35.0%）（p<0.05）。