Sequential Neuroimaging of the Fetus and Newborn With In Utero Zika Virus Exposure
Sequential Neuroimaging of the Fetus and Newborn With In Utero Zika Virus Exposure
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DOI：
10.1001/jamapediatrics.2018.4138
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发表时间：
2019-01-01
期刊：
影响因子：
26.1
通讯作者：
du Plessis, Adre J.
中科院分区：
文献类型：
--
作者：
Mulkey, Sarah B.;Bulas, Dorothy, I;du Plessis, Adre J.
重要性寨卡病毒（ZIKV）感染引起的胎儿脑损伤的演变没有得到很好的描述。为了使用伴随的磁共振成像（MRI）和超声检查（US）对暴露于子宫内母体ZIKV感染的胎儿和婴儿进行纵向神经成像，以及确定感染ZIKV的孕妇中病毒血症的持续时间以及病毒血症的持续时间是否与胎儿和/或妊娠相关。设计、设置和参与者在哥伦比亚的巴兰基利亚和华盛顿特区，从2016年6月15日至2017年6月27日，通过社区招聘、医生推荐和旅行确定的哥伦比亚妇女，从先天性寨卡计划招募的美国妇女的相关病例。干预和暴露妇女在第二和/或第三个三个月期间接受更多的MRI和US检查。出生后，婴儿接受脑部MRI和头颅US。血液样本进行了测试ZIKV.Main结果和措施的神经影像学研究进行了评估，脑损伤和脑biometry. Results的82名妇女，80名来自哥伦比亚和2名来自美国。在82例病例中的3例（4%）中，胎儿MRI显示与先天性ZIKV感染一致的异常。2例出现异位和皮质发育畸形，1例出现顶叶脑膨出、基亚里II畸形和小头畸形。在1例病例中，尽管在MRI上检测到胎儿异常，但US结果仍然正常。1例患者的母体聚合酶链反应阳性时间延长。其余79例产前影像学检查结果正常的婴儿中，53例出生后进行了脑MRI检查，其中7例（13%）表现出轻度异常。57例婴儿出生后行头颅超声检查，发现脑纹血管病变、脉络丛囊肿。结论和相关性在一组ZIKV感染的孕妇中，产前超声检查似乎能检测到除1例胎儿异常外的所有胎儿异常。出生前影像正常的婴儿出生后的神经影像学检查显示新的轻度异常。对于大多数患者，产前和产后US可以识别ZIKV相关的脑损伤。
IMPORTANCE The evolution of fetal brain injury by Zika virus (ZIKV) infection is not well described.OBJECTIVES To perform longitudinal neuroimaging of fetuses and infants exposed to in utero maternal ZIKV infection using concomitant magnetic resonance imaging (MRI) and ultrasonography (US), as well as to determine the duration of viremia in pregnant women with ZIKV infection and whether the duration of viremia correlated with fetal and/or infant brain abnormalities.DESIGN, SETTING, AND PARTICIPANTS A cohort of 82 pregnant women with dinical criteria for probable ZIKV infection in Barranquilla, Colombia, and Washington, DC, were enrolled from June 15, 2016, through June 27, 2017, with Colombian women identified by community recruitment and physician referral and travel-related cases of American women recruited from a Congenital Zika Program.INTERVENTIONS AND EXPOSURES Women received tor more MRI and US examinations during the second and/or third trimesters. Postnatally, infants underwent brain MRI and cranial US. Blood samples were tested for ZIKV.MAIN OUTCOMES AND MEASURES The neuroimaging studies were evaluated for brain injury and cerebral biometry.RESULTS Of the 82 women, 80 were from Colombia and 2 were from the United States. In 3 of 82 cases (4%), fetal MRI demonstrated abnormalities consistent with congenital ZIKV infection. Two cases had heterotopias and malformations in cortical development and 1 case had a parietal encephalocele, Chiari II malformation, and microcephaly. In 1case, US results remained normal despite fetal abnormalities detected on MRI. Prolonged maternal polymerase chain reaction positivity was present in 1 case. Of the remaining 79 cases with normal results of prenatal imaging, postnatal brain MRI was acquired in 53 infants and demonstrated mild abnormalities in 7 (13%). Fifty-seven infants underwent postnatal cranial US, which detected changes of lenticulostriate vasculopathy, choroid plexus cysts. germinolytic/subependymal cysts, and/or calcification in 21infants (37%).CONCLUSIONS AND RELEVANCE In a cohort of pregnant women with ZIKV infection, prenatal US examination appeared to detect all but 1 abnormal fetal case. Postnatal neuroimaging in infants who had normal prenatal imaging revealed new mild abnormalities. For most patients, prenatal and postnatal US may identify ZIKV-related brain injury.