Head Ultrasound and MRI in the Assessment of Congenital Cytomegalovirus: Should there be a Policy Change?

Background - Brain imaging is an important tool in the early assessment of central nervous system involvement in congenital cytomegalovirus (cCMV). However, there is no consensus regarding the optimal neuroimaging modality in these children.

Objective - To assess the differences between head US performed in the neonatal period and MRI done later in life for selected symptomatic children with cCMV.

Methods - Data from files of symptomatic infants with cCMV infection who underwent brain US during the first 4 weeks of life and MRI later in life was collected. Comparison of radiological findings between the two modalities was drawn.

Results - 39 children with symptomatic cCMV were enrolled. MRI was done at the mean age of 33 months. Head US was reported as normal or with isolated LSV in 18 cases. Among these children MRI was normal in 8 and abnormal in 10. 21 children had abnormal US findings during the neonatal period, of which 16 children demonstrated abnormal MRI findings. A strict correlation between US and MRI findings, including major findings such as calcification or ventriculomegaly could not be found. Altogether, concordant results between head US to MRI was presented in 61.5% of cases and was higher in children with abnormal US (76.2%) compared to normal (44%).

Conclusion - We found a significant discrepancy between head US and MRI findings in selected symptomatic cCMV children. These findings in symptomatic children may suggest the importance of MRI in the diagnosis and management of cCMV.