From Fetal to Neonatal Neuroimaging in TORCH Infections: A Pictorial Review

Abstract

Congenital infections represent a challenging and varied clinical scenario in which the brain is frequently involved. Therefore, fetal and neonatal neuro-imaging plays a pivotal role in reaching an accurate diagnosis and in predicting the clinical outcome. Congenital brain infections are characterized by various clinical manifestations, ranging from nearly asymptomatic diseases to syndromic disorders, often associated with severe neurological symptoms. Brain damage results from the complex interaction among the infectious agent, its specific cellular tropism, and the stage of development of the central nervous system at the time of the maternal infection. Therefore, neuroradiological findings vary widely and are the result of complex events. An early detection is essential to establishing a proper diagnosis and prognosis, and to guarantee an optimal and prompt therapeutic perinatal management. Recently, emerging infective agents (i.e., Zika virus and SARS-CoV2) have been related to possible pre- and perinatal brain damage, thus expanding the spectrum of congenital brain infections. The purpose of this pictorial review is to provide an overview of the current knowledge on fetal and neonatal brain neuroimaging patterns in congenital brain infections used in clinical practice.

Congenital Zika syndrome

“…4A and B), increased fluid spaces (ventricular and extra-axial) (Fig. 4C and D), cortical thinning with abnormalities in the convolutions (polymicrogyria, pachygyria, and agyria), hypoplasia or absence of the corpus callosum, decreased myelin, and hypoplasia of the cerebellum or cerebellar vermis [67][68][69] .…”

“…Furthermore, the detection of NNT in samples with negative IgM and positive IgG markers 73 . When congenital infection is suspected, it is advisable to perform laboratory tests to determine the presence of cytomegalovirus, herpes simplex, rubella, human immunodeficiency virus, toxoplasmosis, and syphilis infection to rule out other possible etiologies 54,69 .…”

Neonatal herpes simplex virus infection: From the maternal infection to the child outcome

“…Furthermore, diffusion‐weighted imaging (DWI) sequences show early cortical involvement followed by subcortical white matter involvement during the infection's first phase (Figure 1). 42 …”

“…Corpus callosum agenesis, microphthalmia, and meningeal involvement have also been described. Postnatal magnetic resonance imaging (MRI) is the gold standard for diagnosis thanks to the availability of both morphological and advanced functional sequences such as perfusion arterial spin labeling (ASL) and spectroscopic (MRS) sequences 42 …”

“…Postnatal magnetic resonance imaging (MRI) is the gold standard for diagnosis thanks to the availability of both morphological and advanced functional sequences such as perfusion arterial spin labeling (ASL) and spectroscopic (MRS) sequences. 42 During the acute and subacute phases of infection, the temporal-insular cortical gray matter and subcortical white matter are heavily involved. The basal ganglia, capsules, brainstem, and cerebellum are frequently spared.…”