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E1648. Shining a Torchlight on Congenital Cytomegalovirus Infection
Authors
  1. April Griffith; University of Utah Health
  2. Anne Kennedy; University of Utah Health
  3. Paula Woodward; University of Utah Health
Background
Cytomegalovirus (CMV) is the most common congenital infection worldwide with no vaccine, safe or effective therapy, or widespread screening program. Transplacental fetal infection, especially during the first trimester, is the most common infectious cause of intellectual impairment and is responsible for up to 10% of cases of cerebral palsy. Serial prenatal ultrasounds and fetal MRI are highly sensitive for diagnosis of cerebral involvement whereas negative fetal imaging by ultrasound and MRI has a strong negative predictive value for brain anomalies. In the following exhibit, we will present the current CMV testing regimen in pregnant women, review the cerebral and noncerebral imaging findings of prenatal CMV infection, and help elucidate how to distinguish CMV infection from other infectious and noninfectious mimics.

Educational Goals / Teaching Points
1. Understand screening serology 2. Recognize fetal manifestations of congenital CMV and their importance 3. Distinguish findings of congenital CMV from other diagnostic mimics

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
1. Serum screening and diagnostic testing 2. Cerebral and noncerebral fetal ultrasound findings of congenital CMV with corresponding fetal MRI findings 3. Differential diagnosis, including other congenital infections, nonimmune causes of fetal hydrops, and causes of echogenic bowel

Conclusion
CMV is a common fetal infection with potentially devastating neurologic consequences. As radiologists, it is vital to recognize the constellation of abnormal imaging findings in order to make an accurate diagnosis. Conversely, negative brain findings are equally important for prognostication in patients who demonstrate positive CMV serology.