945. Fetal and Postnatal Brain Imaging for the Detection of ZIKV Encephalopathy in the Fetus/Newborn
Session: Oral Abstract Session: Emerging Paradigms: Pediatric Viral Infections
Friday, October 6, 2017: 8:45 AM
Room: 01AB
Background:

Up to 15% of pregnancies complicated by maternal ZIKV infection result in Zika-virus associated brain abnormalities in the fetus/newborn. Fetal ultrasound (feUS) is the standard imaging modality for the evaluation of fetal anatomy and for brain changes from congenital infection. Fetal MRI (feMRI) may be a useful adjunct.

Methods:

We performed a prospective longitudinal neuroimaging study of fetuses/newborns of pregnant women with clinical and/or lab confirmed (RT-PCR and/or IgM/PRNT) diagnosis of Zika infection in Barranquilla, Colombia (endemic) and in Washington, DC, USA (travel-related). Gestational age (GA) at exposure and timing between ZIKV exposure/symptoms and imaging was documented. Subjects had 1 to 2 feMRIs and feUS, depending upon GA at enrollment. The feMRI and feUS protocols were standardized between sites and studies were centrally interpreted at Children’s National. Postnatally, infants received an unsedated brain MRI and head US.

Results:

Forty-eight, ZIKV exposed/infected in first or second trimester pregnant women were enrolled (46 Colombia, 2 USA). Subjects had symptoms of ZIKV infection at mean of 8.4 ± 5.7 wks GA. The first feMRI and feUS were performed at 25.1 ± 6.3 wks GA. Thirty-six infants had a second feMRI and feUS at 31.1 ± 4.2 wks GA. Three of 48 (6%) cases had an abnormal feMRI: (1) heterotopias and abnormal cortical indent, (2) parietal encephalocele and Chiari II, (3) thin corpus callosum, dysplastic brainstem, temporal cysts, subependymal heterotopias, and generalized cerebral/cerebellar atrophy. FeUS in these 3 cases found (1) normal study, (2) parietal encephalocele and Chiari II, (3) significant ventriculomegaly with decreasing percentiles of head circumference from 32 to 36 wks GA (38% to 3.6%). Postnatal head US revealed findings not seen on feUS: choroid plexus or germinal matrix cysts in 9 infants and lenticulostriate vasculopathy in 1 infant.

Conclusion:

FeMRI and feUS provide complimentary information in the assessment of fetal brain changes in ZIKV. In cases of abnormal brain structure, feMRI reveals more extensive areas of brain damage than is seen by US. Further studies are needed to determine if cystic changes on postnatal head US are related to ZIKV infection, or are incidental findings.

Sarah Mulkey, MD, PhD1, Gilbert Vezina, MD2, Yamil Fourzali, MD3, Dorothy Bulas, MD2, Margarita Arroyave-Wessel, MPH2, Caitlin Cristante, BS2, Christopher Swisher, BS2, Youssef Kousa, DO, PhD2, Carlos Cure, MD4, Roberta DeBiasi, MD, MS, FIDSA, FPIDS5 and Adre Du Plessis, MBChB, MPH6, (1)Fetal Medicine, Children's National Health System, Washington, DC, (2)Children's National Health System, Washington, DC, (3)Sabbag Radiologos, Barranquilla, Colombia, (4)BIOMELab, Barranquilla, Colombia, (5)Pedatrics (Infectious Diseases, Microbiology, Immunology and Tropical Medicine, Childrens National Health System/GWU School of Medicine, Washington, DC, (6)Fetal Medicine Institute, Children's National Health System, Washington, DC

Disclosures:

S. Mulkey, None

G. Vezina, None

Y. Fourzali, None

D. Bulas, None

M. Arroyave-Wessel, None

C. Cristante, None

C. Swisher, None

Y. Kousa, None

C. Cure, None

R. DeBiasi, None

A. Du Plessis, None

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