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Fetal imaging findings in 17 confirmed and 28 presumed Zika virus infections

Fetal imaging findings in 17 confirmed and 28 presumed Zika virus infections
Abnormality Number of confirmed infections at prenatal and/or postnatal imaging Number of presumed infections with microcephaly and calcifications on CT images or postnatal MR images Comments
Parenchymal volume loss 17 (100) 28 (100)
Mild to moderate 6 (35) 17 (61)
Severe 12 (70) 11 (39)
Cortical abnormalities 16 (94) 28 (100) Fifteen subjects were categorized as having both polymicrogyria and irregular areas of sulci and/or gyri not otherwise specified.
Lissencephaly 2 (12) 6 (21)
Polymicrogyria or pachygyria 11 (65) 14 (50)
Irregular areas of sulci and/or gyri not otherwise specified 5 (29) 21 (75)
Corpus callosum abnormalities 16 (94) 22 (78) CT findings of agenesis and/or dysgenesis of the corpus callosum were frequently difficult owing to relatively large fornices and some anterior corpus callosum being present, but pronounced colpocephaly without visualization of the body of the corpus callosum was used for this diagnosis at CT. At MR imaging and US, direct visualization of the corpus callosum was used for diagnosis.
Ventriculomegaly 16 (94) 27 (96) It can be difficult to characterize ventriculomegaly as mild or moderate, since the occipital horns were often dilated out of proportion to the frontal horns owing to parieto-occipital gray and white matter loss. Asymmetrical ventirculomegaly was observed in 6 of 17 and 5 of 28 of the confirmed and presumed infections, respectively.
Mild 4 (24) 5 (18)
Moderate 7 (41) 9 (32)
Severe 5 (29) 13 (46)
Septations in occipital horns 5 (29) 3 (11)
Cerebellum abnormalities 14 (82) 21 (75) Twelve subjects had abnormalities of cerebellar hemispheres and vermis.
Hemisphere hypoplasia or maldevelopment 14 (82) 11 (39)
Vermis hypoplasia 10 (59) 19 (68)
Brainstem hypoplasia and/or atrophy 12 (70) 6 (21) The high percentage in the confirmed infections reflects that these are predominantly prenatally diagnosed infections compared with the presumed infections, which has many neonates with only postnatal images. Prenatal imaging includes sagittal fetal MR imaging, which allows for better visualization of the brainstem compared with axial postnatal CT.
Calcifications 17 (100) 28 (100) This was an inclusion criterion for the presumed infection cohort.
Periventricular 11 (65) 4 (14) All instances with periventricular calcifications had the periventricular calcifications in areas of parenchymal thinning.
Cortical 4 (24) 4 (14) At times, a layered appearance can be seen with cortical, gray, and white matter.
Gray matter-white matter junction 15 (88) 28 (100)
Basal ganglia and/or thalamus 11 (65) 18 (64)
Brainstem 3 (18) 4 (14)
Cerebellum 1 (6) 1 (4)
Soft tissues of the neck 0 1 (4)
Heterogeneous material, some of which could be thrombus in the region of the confluence of sinuses 9 (53) 8 (28) At unenhanced CT, it is helpful to compare material in the confluence of the sinuses region to the basilar artery to determine if the attenuating and/or heterogeneous material is due to thrombus rather than dehydration and hemoconcentration effect.
NOTE: Numbers in parentheses are percentages.
CT: computed tomography; MR: magnetic resonance; US: ultrasound.
Reproduced with permission from: Soares de Oliveira-Szejnfeld P, Levine D, Suely de Oliveira Melo A, et al. Congenital brain abnormalities and Zika virus: What the radiologist can expect to see prenatally and postnatally. Radiology 2016. DOI: 10.1148/radiol.2016161584. Published Online August 23, 2016. Copyright © RSNA.
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