1- Serviço de Imagiologia, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa
2- Serviço de Neurologia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa
26th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Amsterdam, 9-12 Abril 2016
Background: Cytomegalovirus (CMV) infections are one of the most common congenital infections affecting the central nervous system (CNS). Knowledge of the imaging translation of CMV infection is paramount in all stages of disease and development; it plays an essential role in the decision to terminate or continue pregnancy, in the prognostic evaluation of children or in the diagnosis, when neonatal diagnosis was not obtained. The scope of our work was to review this array of imaging findings, systematizing them in clear groups in order to facilitate this diagnosis.
Material/methods: A review of the imaging files of one center was performed for patients with CMV CNS infections and positive findings on magnetic resonance imaging (MRI). Both fetal and postnatal children and adult images were obtained. Images were acquired in 1.5 and 3 tesla magnets. Imaging characteristics were assessed by two independent neuroradiologists. A structured division of anomalies found by anatomical location and type of lesion was developed.
Results: We organized our findings according to types of lesions and anatomical locations. Anatomical distribution of lesions was first done in supratentorial and infratentorial compartments and further subdivided in lesions involving the grey matter, white matter, periventricular region or intraventricular. Types of lesions were divided into calcifications, destructive lesions, neuronal migration anomalies, myelination anomalies and haemorrhagic lesions. Classical and atypical examples of each kind of lesion were collected. Classic lesion associations suggestive of CMV infections are also shown and discussed.
Conclusions: Abnormal findings in this pathology may involve all SNC structures. An anatomical based discussion is helpful in the assessment of imaging studies. MRI anomalies are classically divided according to suspect time of fetal infection as early or late. This division is not intuitive and some findings, like ventriculomegaly or calcifications, are not specific of the timing of fetal infection. A more structured approach to imaging findings can help both radiologists and clinicians to identify findings of CMV infection. Pattern recognition is essential to imaging assessment. Our paper addresses these issues and emphasizes imaging patterns.
Palavras Chave: CMV congenital infection, magnetic resonance imaging