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. 2020 Jan 6;40(1):110–124. doi: 10.1002/pd.5591

Table 1.

List of possible magnetic resonance imaging (MRI) findings in fetuses with congenital cytomegalovirus (cCMV)

Finding MR characteristics Notes
Brain WM hyperintensities

T2‐hyperintense inhomogeneities of the WM

Low SI on DWI

Low SI on T1w‐/T2w FLAIR

Use MRS?

Subjective

Difficult to interpret particularly in the third trimester

Temporal lobe worst prognosis.

Ventriculomegaly

Increased lateral ventricle size (>10 mm), measured at the atria

Mild: 10‐12 mm

Moderate: 12‐15 mm

Severe: >15 mm

May be uni‐ or bilateral

Mild to moderate: low risk; severe: high risk of sequelae73

Cysts/pseudocysts

Well defined lesions with SI similar to CSF on all sequences

Most often periventricular

Inconsistent nomenclature temporal polar lesions highly predictive of CMV infection
Ventriculitis T1w and T2w hyperintensity of the ventricular rim. On T2WI not visible due to juxtaposition to CSF; T2w‐FLAIR useful if T1 is not informative

Rare finding. Most common lateral ventricles.

Periventricular hyperechogenicity

Intraventricular septations/adhesions Tissue strands (T2w low SI) crossing the ventricles Most common occipital horns
Cortical malformations/polymicrogyria

Cortical infoldings located in abnormal positions;

Thickened cortical ribbon

Blurry gray/WM margins on T2WI/FLAIR

MRI superior to US

Clefts (schizencephaly/porencephaly)

Schizencephaly: transmantle cleft, lined by T2 hypointense (=cortex) ribbon81

Porencephaly: cleft with no cortical lining. Margins may show high T2w/FLAIR hyperintensity

Lesions secondary to disruption. Final manifestation depends on time of insult.
Calcifications

Low T2 and high T1 signal, often subtle

Low T2*/EPI SI

Periventricular > deep gray nuclei > white matter
Cerebellar hypoplasia/dysplasia

Small vermis and/or hemispheres

Increased infra/retrocerebellar space (megacisterna magna >8 mm73)

May have associated focal signal changes (ie hemorrhage, calcifications)

Rare fetal MRI

Common postnatal imaging

Hippocampal dysplasia

Dilated temporal horns

Verticalization of the hippocampal± internal temporal lobe atrophy

Often not described in fetal MRI. Common postnatal imaging. (DeVries)
Lenticullostriate vasculopathy

US diagnosis

Low SI T2WI on basal ganglia

Calcification (low EPI/T2* and high T1 SI) of basal ganglia

Late finding on MRI
Body Hepato/Splenomegaly Increased size of liver and/or spleen Special attention should be payed to signal (easily missed on US)
Liver

Low T1‐ and T2 SI may depict global liver involvement (fibrosis/insufficiency)

May have high T2*/EPI SI

Intrahepatitic calcifications better identified on US
Effusions (pericardial, pleural, ascitis)

Fluid collections in the pericardial, pleural or abdominal cavities.

Identical signal to CSF/AF on all sequences.

Pulmonary hypoplasia may ensue secondary to pleural effusion or ascites105

Skin edema

Increased thickness of skin + subcutaneous tissue

High T2 SI, low T1 SI

Hyperechogenic bowel

No findings on MRI

Increase T1w meconium signal if blood ingestion

US change. MRI normal if no associated anomalies103

Other Placenta

Placentomegaly placental thickness (>40 mm)

Inhomogeneity on T1/T2

May have T2*/EPI

Amniotic fluid

Oligo‐/Polyhydramnious

High T1SI if intra‐amniotic hemorrhage

T2 low sensitivity to hemorrhage

FLAIR may show false positive to hemorrhage (high SI) due to fetal movement

Abbreviations: AF, amniotic fluid; CSF, cerebral‐spinal fluid; IUGR, intrauterine growth restriction; SSFP, steady‐state free precession; WI, weighted images; WM, white matter.