Fetal cytomegalovirus infection of the brain: the spectrum of sonographic findings

Abstract

Background and purpose: Congenital cytomegalovirus (CMV) infection can cause a wide range of brain anomalies. These changes have been well described postnatally, but descriptions of their in utero evolution are scarce. The purpose of this study was to analyze the sonographic spectrum of intracranial abnormalities in fetuses with proved CMV infection and to determine characteristic patterns of this infection.

Methods: We reviewed the transabdominal and transvaginal sonograms of eight fetuses with proved CMV infection. The sonographic analysis searched for signs of ventriculitis, leukomalacia, calcification, vasculitis, and periventricular cyst formation. The gyral pattern, corpus callosum, and cerebellar morphology also were examined. Fetal MR imaging was performed in two cases.

Results: The sonographic diagnosis of suspected CMV infection was made at a mean gestational age of 27.5 weeks (range, 22-37 weeks). An abnormal pattern of periventricular echogenicity was found in all fetuses. Echogenic intraparenchymal foci and ventriculomegaly were present in five fetuses. Other signs of fetal infection were intraventricular adhesions, periventricular pseudocysts, sulcation and gyral abnormal patterns, hypoplastic corpus callosum, cerebellar and cisterna magna abnormalities, and signs of striatal artery vasculopathy. For all fetuses, transvaginal sonography provided additional information. Fetal MR imaging provided additional information in one case.

Conclusion: The presence of the described sonographic findings, particularly if two or more are present in the same fetus, is an indication for CMV investigation.

Fig 1.

Fetus 1. Parasagittal transvaginal sonogram of the fetal brain at 25 weeks’ gestation shows abnormal periventricular hyperechogenicity (arrows) and intraventricular adhesion (arrowhead).

Fig 2.

Fetus 3. A, Parasagittal transvaginal sonogram of the fetal brain at 22 weeks’ gestation shows abnormal periventricular echogenicity with cystic formation (arrow) and striatal artery vasculopathy (arrowhead). Observe the presence of ventriculomegaly. B, Sagittal transvaginal sonogram shows large cisterna magna (cm) and 4th ventricle (v), with hypoplastic vermis (arrow).

Fig 3.

Fetus 7. A, Parasagittal transvaginal sonogram of the fetal brain at 37 weeks’ gestation shows periventricular tissue protruding through an undefined ependyma (arrow). B, Parasagittal sonogram shows a periventricular cyst (p) protruding into a large lateral ventricle.

Fig 4.

Fetus 5. Parasagittal transvaginal sonogram of the fetal brain at 31 weeks’ gestation shows abnormal underdeveloped pre- and postcentral gyri and calcifications (arrows).

Fig 5.

Fetus 2. A, Coronal transvaginal sonogram of the fetal brain at 29 weeks’ gestation shows parenchymal foci of increased echogenicity consistent with calcifications (solid arrows) and abnormal sulcation (open arrows). B, Sagittal transvaginal sonogram shows hypoplastic, blurred corpus callosum. The genu of the corpus callosum is not observed (open arrows), the splenium is thin (solid arrow). csp indicates cavum septum pellucidum. C,Sagittal transvaginal sonogram shows cerebellar echogenic foci (arrow).