Background: Congenital cytomegalovirus (CMV) infection can lead to severe neurological sequelae, but a defined brain magnetic resonance (MR) pattern and MR predictors of clinical outcome are still lacking.
Materials and methods: Clinical and MR findings of 14 children with symptomatic congenital CMV infection were retrospectively reviewed.
Results: Microcephaly, cerebral palsy and epilepsy were found in eight, six and seven patients, respectively (all concomitant in 6); 12 children developed sensory-neural hearing loss (SNHL). At first MRI (mean age 21 months, range 5-54 months), white matter (WM) involvement was not assessable in two children due to incomplete myelination. WM abnormalities were common (11/12 patients); deep WM was predominantly involved in 5/11; the largest WM lesion was in the parietal lobe in 6/11. Anterior temporal lobe abnormalities were found in 13/14. Six children underwent MRI examination after 2 years of life; in this subgroup, WM abnormalities were extensive and confluent (4/6), bilateral and multifocal (1/6) or absent (1/6). Four children showed a progression of myelination. Ventriculomegaly (9/14), migration disorders (6/14 polymicrogyria and 1/14 pachygyria-lissencephaly) and hippocampal dysplasia (6/14) correlated with severe neurological sequelae (p < 0.05, Fisher exact test), while the presence of WM abnormalities (11/12), periventricular cysts (6/14) and cerebellar hypoplasia (4/14) did not predict the outcome.
Conclusions: The spectrum of brain MR abnormalities in symptomatic congenital CMV infection is extremely wide. WM involvement is variable, difficult to evaluate at a very young age and unrelated to clinical outcome, while cortical malformations, ventriculomegaly and hippocampal dysplasia seem to be strong predictors of poor outcome except for SNHL.