Congenital Cytomegalovirus Infection With Isolated " Minor " Lesions at Fetal Magnetic Resonance Imaging: Long-Term Neurological Outcome

Background: The prognostic relevance of fetal/early postnatal magnetic resonance (MR) imaging (MRI) isolated "minor " lesions in congenital cytomegalovirus (CMV) infection is still unclear, because of the heterogeneity of previously reported case series. The aim of this study was to report the imaging and long-term clinical follow-up data on a relatively large cohort of infected fetuses. Methods: Among 140 CMV-infected fetuses from a single -center 12 -year -long fetal MRI database, cases that showed isolated "minor " lesions at MRI, mainly represented by polar temporal lesions, were selected. MRI features were described, and clinical follow-up information was collected through consultation of medical records and telephone interview to establish the auditory and neurological outcome of each patient. Results: Thirty-six cases were included in the study. The frequency of "minor " lesions increased progressively with ongoing gestational age in cases who underwent serial MR examination; 31% of cases were symptomatic at birth for unilateral altered auditory brainstem response. At long-term clinical follow-up, performed in 35 patients at a mean age of 64.5 months (range: 25 to 138), 43% of patients were asymptomatic and 57% presented with mild/moderate disability including hearing loss (34%), unilateral in all cases but one (therefore classi fied as severe), and/or minor cognitive and behavioral disorders (49%). Conclusions: Descriptive analysis of the type and modality of occurrence of "minor" lesions suggests performing serial fetal/postnatal MR examinations not to miss later -onset lesions. Follow-up data from the present cohort, combined with maternal/fetal factors and serologic -laboratory parameters may contribute to improve prenatal and neonatal period counselling skills. (c) 2024 Elsevier Inc. All rights reserved.