Van den Eede Emma, De Keersmaecker Bart, Lagrou Katrien, Van der Veeken Lennart, Vanwinkel Sanne, Vangoitsenhoven Maja, Aertsen Michael, De Catte Luc
Department of Development and Regeneration, Biomedical Sciences KU Leuven, Leuven, Belgium.
Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.
Acta Obstet Gynecol Scand. 2025 Feb;104(2):302-308. doi: 10.1111/aogs.15018. Epub 2024 Dec 1.
To investigate the prevalence and timing of prenatal neurosonographic abnormalities after primary cytomegalovirus seroconversion by the first trimester of pregnancy. The additional value of magnetic resonance imaging (MRI) and the correlation between cytomegalovirus viral load in amniotic fluid and adverse neonatal outcomes were evaluated.
A retrospective study between 2006 and 2022 examined data from 440 women with amniocentesis for periconceptional and first-trimester cytomegalovirus seroconversion. Cases with positive amniocentesis and subsequent follow-up were included. Prenatal neurosonography, MRI, and clinical outcomes were analyzed.
Out of 190 women included, 37% (n = 70) presented with a normal neurosonography. Patients exhibiting abnormal neurosonography findings showed higher viral loads in amniotic fluid compared to those with a normal neurosonography (p = 0.002). In 26% (n = 49) the first abnormal ultrasound sign was already picked up at amniocentesis, and the most common ones were echogenic bowels (49%) and periventricular echogenicity (43%). With increasing gestational age, the likelihood of a new abnormal neurosonography finding decreases. MRI discovered additional abnormalities in 14% (n = 10).
The results highlight the importance of combining diagnostic modalities, from amniocentesis to biweekly ultrasound monitoring and subsequent MRI evaluation, to capture the chronological progression and subsequent outcome of congenital cytomegalovirus.
研究妊娠早期原发性巨细胞病毒血清转化后产前神经超声异常的患病率和时间。评估磁共振成像（MRI）的附加价值以及羊水巨细胞病毒载量与不良新生儿结局之间的相关性。
一项回顾性研究，对2006年至2022年间440例因围孕期和孕早期巨细胞病毒血清转化而行羊膜腔穿刺术的妇女的数据进行了检查。纳入羊水穿刺阳性及随后随访的病例。分析产前神经超声、MRI及临床结局。
纳入的190例妇女中，37%（n = 70）神经超声检查正常。与神经超声检查正常的患者相比，神经超声检查结果异常的患者羊水病毒载量更高（p = 0.002）。26%（n = 49）的患者在羊水穿刺时就已发现首个异常超声征象，最常见的是肠回声增强（49%）和脑室周围回声增强（43%）。随着孕周增加，出现新的神经超声异常发现的可能性降低。MRI发现了14%（n = 10）的额外异常。
结果强调了从羊水穿刺到每两周一次的超声监测以及随后的MRI评估等多种诊断方式相结合的重要性，以掌握先天性巨细胞病毒感染的时间进展及后续结局。
