RSNA 2016

Abstract Archives of the RSNA, 2016


PD232-SD-WEA3

Essentials of Intrauterine Zika Virus Infection: Pre and Postnatal CNS Findings

Wednesday, Nov. 30 12:15PM - 12:45PM Room: PD Community, Learning Center Station #3



Heron Werner, MD, Rio de Janeiro, Brazil (Presenter) Nothing to Disclose
Bianca Guedes Ribeiro, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Luiz Celso H. Da Cruz, MD, Rio De Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Pedro Daltro, MD, Rio De Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Renata A. Nogueira, MD, Rio De Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Tatiana M. Fazecas, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Leise Rodrigues, Rio De Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Jorge Lopes, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Gerson Ribeiro, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Arine S. Pecanha, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
PURPOSE

Zika virus (ZIKV) owns to the family of flavivirus and as for dengue and chikungunya infections may recognized Ae. Aegypti and Ae. Albopictus mosquitoes as transmission agents. This virus has tropism for the central nervous system (CNS) and has been strongly associated with common findings to congenital infections, with some features which are described in this presentation.

METHOD AND MATERIALS

We performed a prospective study with seven pregnant patients with ZIKV infection at different gestational ages. They were subjected to ultrasound and fetal MRI.After birth, the newborns performed transfontanellar US, CT and MRI of the head, with posterior 3D reconstructions of the skull.We compared the cases with and without CNS involvement in the patients with intrauterine ZIKV infection. We quantified and illustrated the most frequent findings in the patients who had changes in their CNS.The main findings of CNS abnormalities were reported and several specific findings were displayed on a chart, including microcephaly, and submitted to statistical analysis.

RESULTS

From the 7 cases of ZIKV infection, 4 showed brain abnormalities with microcephaly.Multiple calcifications with cortical and mainly subcortical distribution were seen in all of these 4 cases.Significant thinning of the brain parenchyma, which have extensive periventricular areas of hyperintensity on T2 MR-WI were reported in all of the 4 cases. Neuronal migration anomalies were reported in 3 cases.Dysgenesis of the corpus callosum and ventricular enlargement secondary to cortical/subcortical atrophy were also detected in all of these 4 cases.The cerebellum was affected only in 1 case.Brain stem was not affected on these 7 cases.

CONCLUSION

Microcephaly with almost complete agyria, hydrocephalus, and multifocal dystrophic calcifications in the cortex and subcortical white matter, with associated cortical displacement were the main findings on intrauterine ZIKV infection with CNS involvement.

CLINICAL RELEVANCE/APPLICATION

Brain calcifications detected prenatally was a finding suspicious with a intrauterine infection. Moreover, perinatal imaging by MRI and CT scan enabled diagnosis of pachygyria, corpus callosum dysgenesis, small anterior fontanel with premature closure of cranial sutures.All of these aspects are seen in the majority of the intrauterine ZIKV infection with CNS involvement and it can be considered on diagnosis criteria.