Evaluation of the frequency of neuroimaging findings in congenital infection by Zika virus and differences between computed tomography and magnetic resonance imaging in the detection of alterations

Abstract

Introduction: Congenital infection by the Zika virus (ZIKV) is responsible for severe abnormalities in the development of the central nervous system. The aim of this study was to evaluate and compare the ability of computed tomography (CT) and magnetic resonance (MR) to detect patterns of involvement of the central nervous system in congenital ZIKV syndrome. Methods: We retrospectively analyzed CT and MR images from 34 patients with congenital ZIKV syndrome and evaluated the differences between the two methods in detecting alterations. Results: The predominant radiographic finding was a simplified gyral pattern, present in 97% of cases. The second most common finding was the presence of calcifications (94.1%), followed by ventriculomegaly (85.3%), dysgenesis of the corpus callosum (85.3%), craniofacial disproportion and redundant scalp (79.4%), complete opercular opening (79.4%), occipital prominence (44.1%), cerebellar hypoplasia (14.7%), and pontine hypoplasia (11.8%). The gyral pattern was extensively simplified in most cases, and calcifications were located predominantly at the cortical-subcortical junction. CT was able to better identify calcifications (94.1% × 88.2%), while MRI presented better spatial resolution for the characterization of gyral pattern (97% × 94.1%) and corpus callosum dysgenesis (85.3% × 79.4%). Conclusions: Although congenital ZIKV syndrome does not present pathognomonic neuroimaging findings, some aspects, such as calcifications at the cortical-subcortical junction, especially when associated with compatible clinical and laboratory findings, are suggestive of intrauterine ZIKV infection.

Clinical spectrum of congenital Zika virus infection in Brazil: Update and issues for research development

“…In addition, a previous study conducted in a pediatric cohort (n=23) followed from birth until 36 months reported the development of postnatal microcephaly, mainly in children with severe brain abnormalities at birth 39 . Brain imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) showed calcifications, ventriculomegaly, and diffuse cortical atrophy, which are now part of the diagnostic criteria 31 , 35 , 40 - 42 . A multicenter study of 83 children born with microcephaly at the peak of the epidemic, recruited from 10 Brazilian states, highlighted a phenotype known as the fetal brain disruption sequence, which is rarely observed in other congenital infections 43 .…”

Prenatal Zika virus infection has sex-specific effects on infant physical development and mother-infant social interactions

“…Since the initial reports and observations of ZIKV affecting development, it has become clear that there is variation in the extent to which exposure to ZIKV during fetal development [herein, for brevity referred to as fetal ZIKV (fZIKV)] affects the developing brain and that children born with normal-sized heads and brains may also be affected. Children with congenital ZIKV syndrome (CZS), which presents both with and without microcephaly, have a myriad of neurological symptoms, including ventriculomegaly, lissencephaly, areas of calcification and cysts throughout the brain, and cortical malformations (2)(3)(4)(5)(6)(7). Children with CZS can present smaller in size and weight (8)(9)(10) and may exhibit muscle weakness, loss of reflexes, dyspnea, hypertonia, spasticity, arthrogryposis, epilepsy, and developmental delays and may have severe learning disabilities [for a review, see (11)].…”