MRI findings in children with congenital cytomegalovirus infection retrospectively diagnosed with dried umbilical cord
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PAEDIATRIC NEURORADIOLOGY
MRI findings in children with congenital cytomegalovirus infection retrospectively diagnosed with dried umbilical cord Hiroyuki Kidokoro 1 & Anna Shiraki 1 & Yuka Torii 1 & Masaharu Tanaka 1 & Hiroyuki Yamamoto 1 & Hirokazu Kurahashi 2 & Koichi Maruyama 3 & Akihisa Okumura 2 & Jun Natsume 1 & Yoshinori Ito 1 Received: 30 August 2020 / Accepted: 10 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Brain MRI provides important information about suspected congenital CMV infection in neonatally underdiagnosed children. This study aimed to describe MRI findings in children in whom congenital CMV infection was not suspected during the neonatal period and was proven retrospectively. Methods We enrolled 31 children referred to the pediatric neurology clinic with neurological symptoms who were proven to have congenital CMV infection based on dried umbilical cord samples. Upon diagnosis, MR and CT images were assessed using the van der Knaap scoring system integrated with additional variables. Two investigators independently assessed all images. Results The age at diagnosis was < 12 months in 14, 12–24 months in 11, and > 24 months in 6 patients. The initial symptom triggering clinic referral was delayed development in 22, seizure in 5, deafness in 3, and hemiplegia in 1 patient. Of the 31 children, 30 had a white matter (WM) abnormality predominant in the deep WM of the parietal lobe (n = 25). Anterior temporal lesions were observed in 21 children. Cortical lesions were observed in 7 children, suggestive of polymicrogyria. No child had cerebellar or brainstem abnormalities. Brain CT was performed in 22 of 31 children, and 11 showed punctate cerebral calcification in the periventricular and/or deep WM. Conclusion Patients with congenital CMV infection with delayed neurological symptoms show a relatively uniform pattern of parietal-dominant multifocal WM lesions and anterior temporal lesions, with or without polymicrogyria. Keywords Cytomegalovirus . MRI . PCR . Umbilical cord . Brain injury
Abbreviations CMV Cytomegalovirus SGA Small for gestational age
Introduction Congenital cytomegalovirus (CMV) infection occurs in approximately 0.25–2% of live births [1–4], but approximately * Hiroyuki Kidokoro [email protected] 1
Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, Japan
2
Department of Pediatrics, Aichi Medical University, Nagakute, Japan
3
Division of Pediatric Neurology, Aichi Developmental Disability Center, Kasugai, Japan
90% of congenital CMV infections are asymptomatic during the neonatal period. Among such neonatally asymptomatic infants, some develop sensorineural hearing loss and/or developmental delay first recognized from late infancy through childhood. However, it is difficult to confirm congenital CMV infection beyond the neonatal period. MRI plays an important role in the suspicion of congenital CMV infection. Typical MRI findings include white matt
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