Congenital cytomegalovirus infection with isolated “minor” lesions at fetal MR imaging: long term neurological outcome.

Objective Prognostic relevance of fetal/early postnatal MRI isolated “minor” lesions in congenital Cytomegalovirus (CMV) infection is still unclear, because of 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. Study design Among 140 CMV infected fetuses from a single centre 12 year-long fetal MRI database, cases who showed isolated “minor” lesions at MRI, mainly represented by polar temporal lesions, were selected. MRI features were described, and clinical follow-up information were collected through consultation of medical records and telephone interview in order to establish the auditory and neurological outcome of each patient. Results 36 cases were included in the study. Frequency of “minor” lesions increased progressively with ongoing gestational age (GA) in patients who underwent serial MR examination. 31% of cases were symptomatic at birth for unilateral altered auditory brainstem response (ABR). At long-term clinical follow-up, performed in 35 patients at a mean age of 64.5 months (range: 25-138), 43% of patients were asymptomatic and 57% presented with mild/moderate disability including hearing loss (34%), unilateral in all cases but one (therefore classified as severe) and/or minor cognitive and behavioural 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 serological-laboratoristic parameters may contribute to improve prenatal and neonatal period counselling skills.