Objective To evaluate the association between neuroimaging and outcome in infants with congenital cytomegalovirus (cCMV), focusing on qualitative MRI and quantitative diffusion-weighted imaging of white matter abnormalities (WMAs). Methods Multicentre retrospective cohort study of 160 infants with cCMV (103 symptomatic). A four-grade neuroimaging scoring system was applied to cranial ultrasonography and MRI acquired at ≤3 months. WMAs were categorised as multifocal or diffuse. Temporal-pole WMAs (TPWMAs) consisted of swollen or cystic appearance. Apparent diffusion coefficient (ADC) values were obtained from frontal, parieto-occipital and temporal white matter regions. Available follow-up MRI at ≥6 months (N=14) was additionally reviewed. Neurodevelopmental assessment included motor function, cognition, behaviour, hearing, vision and epilepsy. Adverse outcome was defined as death or moderate/severe disability. Results Neuroimaging scoring was associated with outcome (p < 0.001, area under the curve 0.89±0.03). Isolated WMAs (IWMAs) were present in 61 infants, and WMAs associated with other lesions in 30. Although TPWMAs and diffuse pattern often coexisted in infants with IWMAs (p < 0.001), only TPWMAs were associated with adverse outcomes (OR 7.8; 95% CI 1.4 to 42.8), including severe hearing loss in 20% and hearing loss combined with other moderate/severe disabilities in 15%. Increased ADC values were associated with higher neuroimaging scores, WMAs based on visual assessment and IWMAs with TPWMAs. ADC values were not associated with outcome in infants with IWMAs. Findings suggestive of progression of WMAs on follow-up MRI included gliosis and malacia. Conclusions Categorisation of neuroimaging severity correlates with outcome in cCMV. In infants with IWMAs, TPWMAs provide a guide to prognosis. Data are available upon reasonable request.

中文翻译：

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先天性巨细胞病毒感染婴儿的神经影像学及其与结果的相关性：强调白质异常

目的 评估先天性巨细胞病毒 (cCMV) 婴儿的神经影像学与预后之间的关联，重点关注白质异常 (WMA) 的定性 MRI 和定量弥散加权成像。方法 对 160 名 cCMV 婴儿（其中 103 名有症状）进行多中心回顾性队列研究。四级神经影像评分系统适用于≤3个月时采集的颅脑超声检查和MRI。WMA 被分类为多焦点或弥漫性。颞极 WMA (TPWMA) 表现为肿胀或囊性外观。表观扩散系数 (ADC) 值是从额叶、顶枕叶和颞叶白质区域获得的。另外还审查了 ≥6 个月 (N=14) 的可用随访 MRI。神经发育评估包括运动功能、认知、行为、听力、视力和癫痫。不良结果定义为死亡或中度/重度残疾。结果 神经影像评分与结果相关（p < 0.001，曲线下面积 0.89±0.03）。61 名婴儿中存在孤立性 WMA (IWMA)，30 名婴儿中存在与其他病变相关的 WMA。虽然 IWMA 婴儿中 TPWMA 和弥漫性模式经常共存 (p < 0.001)，但只有 TPWMA 与不良后果相关（OR 7.8；95%） CI 1.4 至 42.8），其中 20% 为严重听力损失，15% 为听力损失并伴有其他中度/重度残疾。ADC 值的增加与较高的神经影像学评分、基于视觉评估的 WMA 和带有 TPWMA 的 IWMA 相关。ADC 值与 IWMA 婴儿的结局无关。后续 MRI 发现提示 WMA 进展的结果包括神经胶质增生和软化。结论 神经影像学严重程度的分类与 cCMV 的结果相关。对于患有 IWMA 的婴儿，TPWMA 提供预后指南。数据可根据合理要求提供。