Background

White matter change is a well-known abnormality in congenital cytomegalovirus (cCMV) infection, but grading remains challenging and clinical relevance unclear.

Objective

To investigate if quantitative measurement of white matter apparent diffusion coefficient (ADC) values in magnetic resonance imaging (MRI) of the neonatal brain can predict outcome in cCMV.

Materials and methods

A retrospective, single-center observational study, including patients with cCMV who had a neonatal brain MRI with diffusion-weighted imaging, was performed between 2007 and 2020. Regions of interest were systematically placed in the white matter on the ADC maps. Two pediatric radiologists independently scored additional brain abnormalities. Outcome measures were neonatal hearing and cognitive and motor development. Statistical analysis included simple and penalized elastic net regression.

Results

Neonatal brain MRI was evaluated in 255 patients (median age 21 days, 25–75 percentiles: 14–28 days, 121 male). Gyral abnormalities were noted in nine patients (3.5%), ventriculomegaly in 24 (9.4%), and subependymal cysts in 58 (22.7%). General white matter ADC was significantly higher in patients with neonatal hearing loss and cognitive and motor impairment (P< 0.05). For neonatal hearing loss, simple logistic regression using only general white matter was the best prediction model, with a receiver operating characteristic area under the curve (AUC)=0.76. For cognitive impairment, interacting elastic net regression, including other brain abnormalities and frontoparietal white matter ADC, performed best, with AUC=0.89. For motor impairment, interacting elastic net regression, including other brain abnormalities and deep anterior frontal white matter performed best, with AUC=0.73.

Conclusion

Neonatal white matter ADC was significantly higher in patients with clinical impairments. Quantitative ADC measurement may be a useful tool for predicting clinical outcome in cCMV.

Graphical Abstract

中文翻译：

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新生儿大脑磁共振成像中白质的表观扩散系数值可能有助于预测先天性巨细胞病毒感染的结果

背景

白质变化是先天性巨细胞病毒 (cCMV) 感染的一种众所周知的异常，但分级仍然具有挑战性，临床相关性尚不清楚。

客观的

探讨新生儿大脑磁共振成像 (MRI) 中白质表观扩散系数 (ADC) 值的定量测量是否可以预测 cCMV 的结果。

材料和方法

2007 年至 2020 年间进行了一项回顾性、单中心观察性研究，其中包括接受弥散加权成像新生儿脑 MRI 的 cCMV 患者。感兴趣的区域被系统地放置在 ADC 图上的白质中。两名儿科放射科医生独立对额外的大脑异常进行评分。结果指标是新生儿听力、认知和运动发育。统计分析包括简单和惩罚弹性网回归。

结果

对 255 名患者（中位年龄 21 天，25-75 百分位：14-28 天，121 名男性）进行了新生儿脑部 MRI 评估。9 名患者 (3.5%) 出现脑回异常，24 名患者 (9.4%) 出现脑室扩大，58 名患者 (22.7%) 出现室管膜下囊肿。新生儿听力损失、认知和运动障碍患者一般白质 ADC 显着升高（P < 0.05）。对于新生儿听力损失，仅使用一般白质的简单逻辑回归是最佳预测模型，受试者工作特征曲线下面积（AUC）= 0.76。对于认知障碍，相互作用的弹性网回归，包括其他大脑异常和额顶白质 ADC，表现最好，AUC=0.89。对于运动障碍，相互作用的弹性网回归，包括其他大脑异常和深部前额白质表现最好，AUC = 0.73。

结论

临床损伤患者的新生儿白质 ADC 显着较高。定量 ADC 测量可能是预测 cCMV 临床结果的有用工具。

图形概要