BACKGROUND: Congenital cytomegalovirus (cCMV) can cause brain inflammation/destruction and teratogenic effects. The only validated neuroimaging prognostic categorization for symptomatic cCMV available is based on destructive lesions seen on computed tomography (CT). OBJECTIVE: The aim of this study was to establish the predictive ability of a comprehensive neonatal neuroimaging scale in symptomatic cCMV. METHODS: Twenty-six infants were studied by neonatal cranial ultrasound scans (US; n = 25), CT (n = 11) and magnetic resonance imaging (MRI; n = 9). A previously validated neuroimaging scale comprising calcifications, ventriculomegaly and atrophy was compared to a newly proposed system adding cerebral dysgenesis and white matter disease. The findings were graded from 0 to 3. Neurodevelopmental assessment included motor and cognitive functions, epilepsy, vision, hearing and behavioral disorders. RESULTS: Both scales showed a significant association with outcome (p < 0.005). Our scale was more accurate in predicting death or moderate-severe disability (area under the curve for scores ≥2, 0.88 ± 0.06 vs. 0.80 ± 0.08). All 5 infants with normal neuroimaging survived with intact neurological function. While our scale was highly associated with outcome in patients studied by MRI, it was unable to predict unfavorable outcomes in 2 patients with mildly abnormal US and/or CT. CONCLUSIONS: A comprehensive scale based on US and MRI predicts neurodevelopment in symptomatic cCMV. Significant destructive lesions are associated with a poor prognosis. While a strictly normal cranial US predicts a favorable outcome, in case of subtle US abnormalities, MRI is crucial for prognostication.
BACKGROUND: Congenital cytomegalovirus (cCMV) can cause brain inflammation/destruction and teratogenic effects. The only validated neuroimaging prognostic categorization for symptomatic cCMV available is based on destructive lesions seen on computed tomography (CT). OBJECTIVE: The aim of this study was to establish the predictive ability of a comprehensive neonatal neuroimaging scale in symptomatic cCMV. METHODS: Twenty-six infants were studied by neonatal cranial ultrasound scans (US; n = 25), CT (n = 11) and magnetic resonance imaging (MRI; n = 9). A previously validated neuroimaging scale comprising calcifications, ventriculomegaly and atrophy was compared to a newly proposed system adding cerebral dysgenesis and white matter disease. The findings were graded from 0 to 3. Neurodevelopmental assessment included motor and cognitive functions, epilepsy, vision, hearing and behavioral disorders. RESULTS: Both scales showed a significant association with outcome (p < 0.005). Our scale was more accurate in predicting death or moderate-severe disability (area under the curve for scores ≥2, 0.88 ± 0.06 vs. 0.80 ± 0.08). All 5 infants with normal neuroimaging survived with intact neurological function. While our scale was highly associated with outcome in patients studied by MRI, it was unable to predict unfavorable outcomes in 2 patients with mildly abnormal US and/or CT. CONCLUSIONS: A comprehensive scale based on US and MRI predicts neurodevelopment in symptomatic cCMV. Significant destructive lesions are associated with a poor prognosis. While a strictly normal cranial US predicts a favorable outcome, in case of subtle US abnormalities, MRI is crucial for prognostication.
Authors: T M Lanzieri; J Leung; A C Caviness; W Chung; M Flores; P Blum; S R Bialek; J A Miller; S S Vinson; M R Turcich; R G Voigt; G Demmler-Harrison Journal: J Perinatol Date: 2017-04-06 Impact factor: 2.521
Authors: Megan R Reynolds; Abbey M Jones; Emily E Petersen; Ellen H Lee; Marion E Rice; Andrea Bingham; Sascha R Ellington; Nicole Evert; Sarah Reagan-Steiner; Titilope Oduyebo; Catherine M Brown; Stacey Martin; Nina Ahmad; Julu Bhatnagar; Jennifer Macdonald; Carolyn Gould; Anne D Fine; Kara D Polen; Heather Lake-Burger; Christina L Hillard; Noemi Hall; Mahsa M Yazdy; Karnesha Slaughter; Jamie N Sommer; Alys Adamski; Meghan Raycraft; Shannon Fleck-Derderian; Jyoti Gupta; Kimberly Newsome; Madelyn Baez-Santiago; Sally Slavinski; Jennifer L White; Cynthia A Moore; Carrie K Shapiro-Mendoza; Lyle Petersen; Coleen Boyle; Denise J Jamieson; Dana Meaney-Delman; Margaret A Honein Journal: MMWR Morb Mortal Wkly Rep Date: 2017-04-07 Impact factor: 17.586
Authors: Mariana Kikuti; Cristiane W Cardoso; Ana P B Prates; Igor A D Paploski; Uriel Kitron; Mitermayer G Reis; Ganeshwaran H Mochida; Guilherme S Ribeiro Journal: Euro Surveill Date: 2018-11
Authors: Jennifer A Hranilovich; Albert H Park; Elizabeth D Knackstedt; Betsy E Ostrander; Gary L Hedlund; Kevin Shi; James F Bale Journal: Pediatr Neurol Date: 2020-05-20 Impact factor: 3.372