Congenital Cytomegalovirus (CMV) Brain MRI

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Brain/extra-cerebral sign stratification
   Brain/extra-cerebral sign stratification (with amniotic CMV-PCR and viral load)? (Congenital CMV is the most common congenital infection, brain abnormality is often the first sign. MRI is the gold standard (especially shows temporal pole cysts, white matter T2 high signal, migration), complementary to ultrasound prenatally. Extra-cerebral: FGR/hepatosplenomegaly/ascites/echogenic bowel/enlarged placenta. Amniotic CMV-PCR confirms (6–8 weeks after maternal infection and >17–21 weeks).)
   • Brain and extra-cerebral imaging normal / only isolated minor (isolated white matter high signal) → Imaging essentially normal · follow up
   • Minor brain abnormalities (VM <15 mm, calcification, subependymal/temporal pole cysts, intraventricular septation) → Minor brain abnormalities · integrated assessment
   • Severe brain abnormalities (VM >15 mm, microcephaly, ventriculitis, porencephaly/lissencephaly, white matter cysts, cerebellar hypoplasia, ACC, migration) → Severe brain abnormalities · poor prognosis
2. [End] Imaging essentially normal · follow up
   Imaging normal or only isolated minor white matter high signal: lower (but not zero) risk of adverse neurodevelopment; fetal MRI re-review (temporal pole/white matter/migration) + serial follow-up, attention to hearing (SNHL); for first-trimester maternal infection, assess valaciclovir to reduce vertical transmission.
3. [End] Minor brain abnormalities · integrated assessment
   Minor brain abnormalities (VM <15 mm, calcification, subependymal/temporal pole cysts, intraventricular septation): integrate with viral load and serial imaging; fetal MRI for comprehensive assessment of migration/white matter + infectious/genetic consultation + neonatal hearing and brain imaging follow-up; intermediate prognosis, individualized counseling.
4. [End] Severe brain abnormalities · poor prognosis
   Severe brain abnormalities (VM >15 mm, microcephaly, ventriculitis, porencephaly/lissencephaly, white matter cysts, cerebellar hypoplasia, ACC, migration disorder): high risk of adverse neurodevelopment; fetal MRI for comprehensive assessment + amniotic CMV-PCR/load + multidisciplinary counseling; microcephaly/migration indicate a poor prognosis.

Source guidelines & references

• Congenital CMV brain MRI spectrum and stratification (Prenat Diagn 2020; Leruez-Ville stratification)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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