Cranial ultrasound and MRI: complementary or not in the diagnostic assessment of children with congenital CMV infection?

Annelies Keymeulen; Els De Leenheer; Alexandra Casaer; Veerle Cossey; Nele Herregods; Sabine Laroche; Ludo Mahieu; Christine Van Mol; Sophie Vanhaesebrouck; Caroline Vande Walle; Koenraad Smets

doi:10.1007/s00431-021-04273-y

Cranial ultrasound and MRI: complementary or not in the diagnostic assessment of children with congenital CMV infection?

Eur J Pediatr. 2022 Mar;181(3):911-920. doi: 10.1007/s00431-021-04273-y. Epub 2021 Oct 12.

Authors

Affiliations

¹ Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium. annelies.keymeulen@ugent.be.
² Ear-Nose-Throat Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
³ Neonatology Department, AZ Sint Jan Bruges, Rudderhove 10, 8000, Bruges, Belgium.
⁴ Neonatology Department, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
⁵ Radiology Department, Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
⁶ Neonatology Department, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
⁷ Neonatology Department, Antwerp University, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
⁸ Neonatology Department, GZA Antwerp, Oosterveldlaan 24, 2610, Wilrijk, Belgium.
⁹ Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
¹⁰ Radiology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.

PMID: 34636957
DOI: 10.1007/s00431-021-04273-y

Abstract

Whether or not cranial ultrasound (crUS) and cerebral magnetic resonance imaging (MRI) have both a place in the assessment of children with congenital cytomegalovirus infection (cCMV) remains a topic of discussion between research groups. Literature suggests that MRI is indicated only in children with abnormal crUS.In Flanders, Belgium, combined crUS and MRI was performed on 639 children with cCMV, referred for diagnostic assessment. Cranial US was classified as abnormal in the presence of striatal vasculopathy, calcifications, cysts, cystic germinolysis, and/or ventriculomegaly. MRI findings were classified as abnormal in the presence of gyration disorders, cerebellar abnormalities, ventriculomegaly, cysts, or pathologic white matter lesions.One in five children (93/480) with normal crUS showed abnormal findings on MRI. Of them, 85 (91.4%) were classified as symptomatic. In 37 of those 93 children (39.8%), classification as severely symptomatic was made based on MRI lesions alone. MRI and crUS proved to be complementary in the assessment of CNS involvement in children with cCMV. Long-term studies are needed to evaluate the importance of this finding with respect to outcome and benefit of therapy in this particular subgroup of patients with cCMV infection.Conclusion: Our findings support an enhanced role of MRI in the diagnosis of CNS involvement in children with cCMV infection. The ideal assessment should include both imaging techniques, as the strengths of each test compensate for the other's weaknesses. What is Known: • Congenital CMV infection involves the central nervous system with direct injury to and possible disruption of brain development. • Experts suggest that MRI is indicated only in children with abnormal crUS. What is New: • In almost 20% of our children with a normal cranial ultrasound, abnormalities were detected on MRI. • Our results suggest that performing both MRI and cranial US is important to obtain a complete assessment of central nervous system involvement in children with cCMV.

Keywords: Central nervous system involvement; Congenital cytomegalovirus infection; Imaging techniques; Management.

MeSH terms

Child
Cytomegalovirus Infections* / congenital
Cytomegalovirus Infections* / diagnostic imaging
Humans
Longitudinal Studies
Magnetic Resonance Imaging / methods
Nervous System Diseases*
Ultrasonography