Head Ultrasound or MRI? The Role of Neuroimaging in the Assessment of Symptomatic and Asymptomatic Infants with Congenital CMV Infection

BACKGROUND: Despite interest in universal screening for congenital CMV infection (cCMV), there is little consensus on the management of asymptomatic newborns, and on the role or type of neuroimaging to be performed in infected infants. The objective of this study was to assess the concordance between head ultrasound (US) and magnetic resonance imaging (MRI) in identifying neurological abnormalities in infants with cCMV infection. METHODS: Retrospective review of infants with cCMV infection, referred to the Centre Maternel Infantile d’Infectiologie Congenitale at Sainte-Justine Hospital Center in Montreal, between 2008 and 2016. This was a secondary analysis of a previous study and included only patients who underwent baseline CMV qPCR and had neuroimaging records available. RESULTS: Of 46 cases of cCMV infection, 10 were categorized as clinically asymptomatic, and were identified following maternal seroconversion during pregnancy (8) or during targeted screening of HIV exposed newborns (2). Twenty-eight patients had US followed by MRI, 4 underwent US followed by CT (3) or CT and MRI(1), and 11 had only 1 imaging modality (US, CT, or MRI). Among cases with sequential US and MRI, US was performed at a mean of 13 days (SD ±19) and MRI at a mean of 70 days of age (SD ±164). In 20/28 cases, US and MRI were concordant (9 abnormal, 11 normal). In 4 cases, US was normal and MRI later found to be abnormal; however in these 4 cases patients were clinically symptomatic and the initial imaging findings did not influence the decision to treat. In 4 cases, US was abnormal and subsequent MRI found to be normal; in 2 of these cases, patients were clinically symptomatic and the imaging findings did not influence the decision to treat. However, in 2 cases, the patients were clinically asymptomatic and categorized as symptomatic for treatment based only on the abnormal US findings. CONCLUSION: In this study, there was a discordance between MRI and US findings in 29% of infants with cCMV infection. While the addition of MRI to baseline head ultrasound did not influence the decision to treat in clinically symptomatic infants, the addition of MRI for infants with abnormal head US who are clinically asymptomatic could help refine treatment decisions in these cases. DISCLOSURES: All authors: No reported disclosures.