Mieke M Cannie1,2, Roland Devlieger3, Mina Leyder4, Filip Claus5,6, Astrid Leus2, Luc De Catte3, Veerle Cossey7, Ina Foulon8, Elise Van der Valk3, Walter Foulon4, Teresa Cos9, Anja Bernaert10, Raymond Oyen5, Jacques C Jani11. 1. Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium. 2. Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium. 3. Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium. 4. Department of Obstetrics, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium. 5. Department of Radiology, University Hospitals Leuven, Leuven, Belgium. 6. Department of Radiology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium. 7. Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium. 8. Department of Otolaryngology - Head and Neck Surgery, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium. 9. Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Fetal Medicine Unit, Place A. Van Gehuchten 4, 1020, Brussels, Belgium. 10. Department of Radiology, Sint-Augustinus Hospital, Antwerp, Belgium. 11. Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Fetal Medicine Unit, Place A. Van Gehuchten 4, 1020, Brussels, Belgium. jackjani@hotmail.com.
Abstract
OBJECTIVE: To predict sensorineural hearing loss (SNHL) and neurological impairment in congenital cytomegalovirus (cCMV) infection using MR imaging and define the best timing in pregnancy for prenatal assessment. METHODS: In 121 patients with confirmed cCMV infection, brain features at MR imaging were respectively graded from 1 to 5: normal; isolated frontal/parieto-occipital hyperintensity; temporal periventricular hyperintensity; temporal/occipital cysts and/or intraventricular septa; migration disorders. Grading was correlated with postnatal SNHL and neurological impairment using regression analysis. In 51 fetuses with MR examinations at 26.9 and 33.0 weeks, the predictive value of SNHL and neurological impairment was compared using ROC curves. RESULTS: Postnatal follow-up showed SNHL in 18 infants and neurological impairment in 10. MR grading was predictive of SNHL and of neurological impairment (P < 0.001). In grade 1 or 2, none had SNHL and 1/74 had neurological impairment. The areas under ROC curves for prediction of postnatal SNHL and of neurological impairment from first and second MR examination were comparable. CONCLUSION: Our data suggest that in cCMV infection, prediction of SNHL and neurological impairment is feasible by fetal MR imaging with a high negative predictive value and can equally be done at 27 or 33 weeks of gestation. KEY POINTS: • In cCMV, isolated periventricular T2-weighted signal hyperintensity has a good postnatal prognosis. • In cCMV, SNHL and neurological impairment can be predicted at 27 or 33 weeks. • In cCMV, fetal MR has a high NPV in predicting SNHL. • In cCMV, fetal MR has a high NPV in predicting neurological impairment.
OBJECTIVE: To predict sensorineural hearing loss (SNHL) and neurological impairment in congenital cytomegalovirus (cCMV) infection using MR imaging and define the best timing in pregnancy for prenatal assessment. METHODS: In 121 patients with confirmed cCMV infection, brain features at MR imaging were respectively graded from 1 to 5: normal; isolated frontal/parieto-occipital hyperintensity; temporal periventricular hyperintensity; temporal/occipital cysts and/or intraventricular septa; migration disorders. Grading was correlated with postnatal SNHL and neurological impairment using regression analysis. In 51 fetuses with MR examinations at 26.9 and 33.0 weeks, the predictive value of SNHL and neurological impairment was compared using ROC curves. RESULTS: Postnatal follow-up showed SNHL in 18 infants and neurological impairment in 10. MR grading was predictive of SNHL and of neurological impairment (P < 0.001). In grade 1 or 2, none had SNHL and 1/74 had neurological impairment. The areas under ROC curves for prediction of postnatal SNHL and of neurological impairment from first and second MR examination were comparable. CONCLUSION: Our data suggest that in cCMV infection, prediction of SNHL and neurological impairment is feasible by fetal MR imaging with a high negative predictive value and can equally be done at 27 or 33 weeks of gestation. KEY POINTS: • In cCMV, isolated periventricular T2-weighted signal hyperintensity has a good postnatal prognosis. • In cCMV, SNHL and neurological impairment can be predicted at 27 or 33 weeks. • In cCMV, fetal MR has a high NPV in predicting SNHL. • In cCMV, fetal MR has a high NPV in predicting neurological impairment.
Authors: S Lipitz; C Hoffmann; B Feldman; M Tepperberg-Dikawa; E Schiff; B Weisz Journal: Ultrasound Obstet Gynecol Date: 2010-04-15 Impact factor: 7.299
Authors: Susan P Walker; Ricardo Palma-Dias; Erica M Wood; Paul Shekleton; Michelle L Giles Journal: BMC Pregnancy Childbirth Date: 2013-04-18 Impact factor: 3.007