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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 24:28-32, January 2003
© 2003 American Society of Neuroradiology

PEDIATRICS

Fetal Cytomegalovirus Infection of the Brain: The Spectrum of Sonographic Findings

Gustavo Malinger^a,b, Dorit Lev^a,c, Neriman Zahalka^a,b, Zahi Ben Aroia^a,b, Nathan Watemberg^a,d, Deborah Kidron^e, Liat Ben Sira^f and Tally Lerman-Sagie^a,d

^a Fetal Neurology Clinic, Edith Wolfson Medical Center, Holon, Israel
^b Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
^c Institute of Medical Genetics, Edith Wolfson Medical Center, Holon, Israel
^d Pediatric Neurology Unit, Edith Wolfson Medical Center, Holon, Israel
^e Department of Pathology, Sapir Medical Center, Kfar Saba, Israel
^f Pediatric Radiology Unit, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel

Address reprint requests to Gustavo Malinger, M.D., Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel

BACKGROUND AND PURPOSE: Congenital cytomegalovirus (CMV) infection can cause a wide range of brain anomalies. These changes have been well described postnatally, but descriptions of their in utero evolution are scarce. The purpose of this study was to analyze the sonographic spectrum of intracranial abnormalities in fetuses with proved CMV infection and to determine characteristic patterns of this infection.

METHODS: We reviewed the transabdominal and transvaginal sonograms of eight fetuses with proved CMV infection. The sonographic analysis searched for signs of ventriculitis, leukomalacia, calcification, vasculitis, and periventricular cyst formation. The gyral pattern, corpus callosum, and cerebellar morphology also were examined. Fetal MR imaging was performed in two cases.

RESULTS: The sonographic diagnosis of suspected CMV infection was made at a mean gestational age of 27.5 weeks (range, 22–37 weeks). An abnormal pattern of periventricular echogenicity was found in all fetuses. Echogenic intraparenchymal foci and ventriculomegaly were present in five fetuses. Other signs of fetal infection were intraventricular adhesions, periventricular pseudocysts, sulcation and gyral abnormal patterns, hypoplastic corpus callosum, cerebellar and cisterna magna abnormalities, and signs of striatal artery vasculopathy. For all fetuses, transvaginal sonography provided additional information. Fetal MR imaging provided additional information in one case.

CONCLUSION: The presence of the described sonographic findings, particularly if two or more are present in the same fetus, is an indication for CMV investigation.

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