1 – Neuroradiology Department, Centro Hospitalar de Lisboa Central
2 – Neurology Department, Centro Hospitalar de Lisboa Central
3 – Pediatric Neurology Department, Centro Hospitalar de Lisboa Central
26th ECCMID, 9 - 12 abril 2016, Amsterdão, Países Baixos
Introdução: Cytomegalovirus (CMV) is the most important cause of congenital infection worldwide, resulting from transmission of the virus across the placenta. It is particularly harmful when occurs as a consequence of maternal primary infection during pregnancy. Central nervous system (CNS) involvement is common, resulting in a high prevalence of neurodevelopmental deficits in surviving children, including hearing loss and cognitive impairment. Antenatal diagnosis is therefore of paramount importance. Fetal magnetic resonance imaging (MRI) is a promising technique in the evaluation of the fetal CNS, with possible value in the assessment of infectious lesions. The aim of our study was to characterise brain MRI findings of fetuses with intrauterine CMV infection.
Métodos: We reviewed the brain MRI of fetuses with confirmed CMV infection performed at our centre between September 2009 and November 2015. All MRI were performed at a 1.5 tesla magnet. Each exam was analysed for CNS abnormalities by two neuroradiologists. Prevalence of each finding was assessed and compared and related to the trimester of cmv infection. Pregnancy outcomes were assessed and postnatal clinical evaluations of children reviewed Further analytical control should be performed at the end of surgery and after five days.
Resultados We identified 15 cases of intrauterine CMV infection during the study period, for which 17 fetal MRI were performed. Median gestational age was 32 weeks. Fifteen cases were confirmed by PCR in the amniotic fluid while the remaining two were diagnosed on the basis of antigen detection in the newborn’s urine. Ventricular abnormalities were the most consistent finding, present in 13 exams (76%). White matter changes were seen in six cases (40%), with cystic lesions in three (20%) fetuses. Sulcation pattern was abnormal in two cases (13%). MRI detected abnormalities in three cases with normal ultrasounds, while missing none of the abnormalities shown by ultrasound. Four women opted for termination of pregnancy and five decided to carry the pregnancy to term, two of which had abnormal fetal MRI; one of the children developed hearing loss while the other has mild developmental delay. Of the three children with normal exams: one has hearing loss, one is developing normally at 2 years of age and the remaining child was lost to follow-up. Of the remaining cases, pregnancy result is unknown in 4, while the other two are ongoing.
Conclusões: Fetuses with CMV infection may present with a wide range of cranial MRI abnormalities, ranging from normal, to severe destructive lesions. Knowledge of characteristic imaging findings is essential, as early diagnosis in utero may influence the decision to follow through or terminate pregnancy. Our findings were consistent with the array of abnormalities described in this entity. MRI was a helpful tool and provided important additional information in fetuses with brain abnormalities undetected by ultrasound, which has a significant clinical impact
Palavras Chave: Fetal Magnetic Resonance Imaging, Cytomegalovirus, Congenital infection.