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

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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.

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Abbreviations

AST:

Aspartaat-aminotransferase

ALT:

Alanine-aminotransferase

cCMV:

Congenital cytomegalovirus infection

crUS:

Cranial ultrasound

CNS:

Central nervous system

CMV:

Cytomegalovirus infection

cCMV :

Congenital cytomegalovirus infection

CT:

Computed tomography

LSV:

Lenticulostriatal vasculopathy

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PPV:

Positive predictive value

SNHL:

Sensorineural hearing loss

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Authors and Affiliations

  1. Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Annelies Keymeulen, Sophie Vanhaesebrouck & Koenraad Smets

  2. Ear-Nose-Throat Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Els De Leenheer

  3. Neonatology Department, AZ Sint Jan Bruges, Rudderhove 10, 8000, Bruges, Belgium

    Alexandra Casaer

  4. Neonatology Department, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium

    Veerle Cossey

  5. Radiology Department, Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Nele Herregods

  6. Neonatology Department, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium

    Sabine Laroche

  7. Neonatology Department, Antwerp University, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium

    Ludo Mahieu

  8. Neonatology Department, GZA Antwerp, Oosterveldlaan 24, 2610, Wilrijk, Belgium

    Christine Van Mol

  9. Radiology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Caroline Vande Walle

Authors
  1. Annelies Keymeulen
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  2. Els De Leenheer
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  3. Alexandra Casaer
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  4. Veerle Cossey
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  7. Ludo Mahieu
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  9. Sophie Vanhaesebrouck
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  10. Caroline Vande Walle
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  11. Koenraad Smets
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Contributions

Keymeulen A: conceptualization, methodology, investigation, validation, formal analysis, writing (original draft, visualization). De Leenheer E: writing (review and editing). Casaer A: writing (review and editing), resources. Cossey V: writing (review and editing), resources. Herregods N: resources. Mahieu L: writing (review and editing), resources. Laroche S: writing (review and editing), resources. Van Mol C: writing (review and editing), resources. Vanhaesebrouck S: writing (review and editing). Vande Walle C: writing (review and editing), resources. Smets K: methodology, writing (review and editing), supervision.

Corresponding author

Correspondence to Annelies Keymeulen.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval by the ethics committee of the Ghent University Hospital.

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Informed consent obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Communicated by Nicole Ritz

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Cite this article

Keymeulen, A., De Leenheer, E., Casaer, A. et al. Cranial ultrasound and MRI: complementary or not in the diagnostic assessment of children with congenital CMV infection?. Eur J Pediatr 181, 911–920 (2022). https://doi.org/10.1007/s00431-021-04273-y

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  • DOI: https://doi.org/10.1007/s00431-021-04273-y

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