Anatomical and diffusion‐weighted imaging of brain abnormalities in third‐trimester fetuses with cytomegalovirus infection

Abstract

What are the novel findings of this work? Neurosonography (NSG) and magnetic resonance imaging (MRI) are complementary tools in third-trimester assessment of brain abnormalities in cytomegalovirus (CMV)-infected fetuses with seroconversion in the first trimester, and there is a significant correlation between the grading systems of the two modalities. Apparent diffusion coefficient values in different brain regions of CMV-infected fetuses are abnormal when compared with CMV-negative controls. However, there is a significant risk of failure of diffusion-weighted imaging in 15% of routine clinical scans. What are the clinical implications of this work?Third-trimester findings on MRI and NSG in fetuses with first-trimester CMV infection can be combined for parental counseling and further management of pregnancy. New classification systems of brain abnormalities in CMV-infected fetuses should incorporate findings detected on diffusion-weighted imaging for a more thorough classification.

The Role of Fetal Brain Magnetic Resonance Imaging in Current Fetal Medicine

“…In our study, we evaluated the routine application of diffusion weighted imaging (DWI) in fetuses with proven first-trimester cCMV to evaluate the white matter. Despite a failure rate of >10%, DWI should be implemented in routine fetal MRI for CMV as we found a significant higher ADC value in the brain of cCMV-infected fetuses compared to controls, and our findings suggested a correlation with the severity of abnormalities found on anatomical sequences [3] The higher ADC is in line with a postnatal study comparing cCMV with periventricular leukomalacia (PVL) in children [68].…”

“…Neurosonography (NSG) is the most important modality in the follow-up of fetuses with confirmed first-trimester CMV-infection [ 59 ]. We found an added value of fetal MRI in the third trimester in fetuses with proven first-trimester CMV infection [ 3 ]. Moreover, there is a correlation between grading of abnormalities found at NSG [ 62 ] and those found at MRI [ 5 ].…”

“…Fetal magnetic resonance imaging (MRI) has become an important adjunct to prenatal ultrasound in the assessment of fetal abnormalities of the central nervous system. It has become clear that both modalities are complementary, allowing better understanding of the disease process, classification of abnormalities, and determination of prognosis and management options [ 1 2 3 ]. Over the last decades, several in utero treatment options have been proven beneficial and effective, including laser coagulation in monochorionic pregnancies complicated by twin-to-twin transfusion syndrome (TTTS), in utero closure of spina bifida aperta and, most recently fetoscopic endoluminal tracheal occlusion in congenital diaphragmatic hernia (CDH).…”

Does fetal cerebral magnetic resonance imaging have additional value in cytomegalovirus fetopathy with normal neurosonography?

“…The main concern associated with performing fetal MRI in the context of CMV infection, especially when neurosonography is normal, is the interpretation of anomalies of the white matter, as white‐matter hyperintensities may represent normal variation or relate to transient encephalopathy with no impact on postnatal prognosis. In our experience, reflected in our recent publication 2 and corroborated by previous authors 6–8 , this is one of the main reasons why not to perform fetal MRI in such cases. Therefore, we were surprised to find that Di Mascio et al .…”

Longitudinal MRI Evaluation of Brain Development in Fetuses with Congenital Diaphragmatic Hernia around the Time of Fetal Endotracheal Occlusion

“…Scanning parameters are reported elsewhere. 19 In addition, T2-weighted HASTE sequences, obtained in 3 orthogonal planes relative to the fetal body (coronal, axial, and sagittal) were performed. Scanning parameters were TE ¼ 90 ms; TR ¼ 1000 ms; section thickness ¼ 3.0-4.0 mm; absence of an intersection gap; FOV ¼ 300 Â 300-380 Â 380 mm.…”