Apparent Diffusion Coefficient Levels and Neurodevelopmental Outcome in Fetuses with Brain MR Imaging White Matter Hyperintense Signal

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Fig 1.
ADC calculation was performed on 8 circular ROIs: 2 on the white matter of both frontal (1, 2), parietal (3, 4), temporal (5, 6), and occipital lobes (7, 8). A circular ROI was placed over the desired anatomic area, ranging from 75 to 98 mm².
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Fig 2.
T2 MR images (single-shot fast spin-echo T2-weighted sequences in 3 orthogonal planes using a half-Fourier technique, NEX = 0.53) of 2 fetuses at 33 weeks of gestational age. The CMV-positive fetus has diffuse WMHS (white arrowheads), unilateral ventriculomegaly, and intraventricular adhesions (black asterisks), suggesting ventriculitis (A–C). The CMV-negative fetus has WMHS located in the white matter in the temporal lobes (white arrowhead) (D–F).

Table 1:

Demographic and clinical characteristics of fetuses with white matter T2 hyperintense signal^{^a}

Characteristic	CMV-Positive (n = 22)	CMV-Negative (n = 22)	P Value
Maternal age (yr)	30.5 (26.7–34.2)	31 (28.7–34.2)	.74
Gestational age at MRI (wk)	33 (32–34)	33.5 (32–35)	.69
Previous pregnancies	2 (2–3)	2 (1–4)	.94
Previous labors	1 (1–1.75)	1 (0–2.25)	.95
Abnormal outcome in previous labors	6 (27%)	7 (32%)	.74
Abnormal maternal medical background	0	6 (27%)	.02
Mode of conception	19 (86%)	22 (100%)	.35
Spontaneous
IVF	2 (9%)	0 (0%)
Induced pregnancy	1 (5%)	0 (0%)
Sex (male)	12 (54%)	8 (38%)	.36
Normal nuchal translucency scan results	21 (95%)	22 (100%)	.99
Normal first trimester biochemical test results	21 (94%)	21 (94%)	>.99
Normal second trimester biochemical test results	22 (100%)	22 (100%)	>.99
Normal early anatomic scan findings	22 (100%)	16 (72%)	.02
Normal late anatomic scan findings	21 (94%)	11 (60%)	.009

Note:—IVF indicates in vitro fertilization.
↵a Data are presented as median (interquartile range) for continuous variables or number (percentage) for categoric variables.

Table 2:

Radiologic MR imaging findings^{^a}

	CMV-Positive	CMV-Negative	P Value
Gestational age at MRI (wk)	33 (32–34)	33.5 (32–35)	.6
Radiologic finding
Frontal T2 hyperintense signal	13/22 (59%)	6/22 (27.3%)	.067
Parietal T2 hyperintense signal	14/22 (63.6%)	3/22 (13.6%)	.002
Temporal T2 hyperintense signal	22/22 (100%)	21/22 (95.5%)	>.999
Occipital T2 hyperintense signal	0/22 (0%)	0/22 (0%)	>.999
T2 hyperintense signal at 3 lobes (frontal, parietal, and temporal)	13/22 (59%)	3/22 (13/6%)	.004
Additional findings	1/22 (4.5%)	7/22 (31.8%)	.046

↵a Data are presented as median (interquartile range) for continuous variables or number (percentage) for categoric variables.

Table 3:

Comparison of ADC values of the study group with the control group^{^a}

Lobe, Side	Study Group	ADC	ADC Control	P Value
Frontal
Right	CMV−	1793 (191)	1809 (165)	.754
Right	CMV+	1872 (160)		.160
Left	CMV−	1741 (141)		.115
Left	CMV+	1858 (193)		.302
Parietal
Right	CMV−	1659 (200)	1748 (192)	.099
Right	CMV+	1840 (140)		.057
Left	CMV−	1690 (188)		.268
Left	CMV+	1852 (138)		.03
Temporal
Right	CMV−	1702 (169)	1692 (164)	.843
Right	CMV+	1835 (161)		.002
Left	CMV−	1689 (193)		.933
Left	CMV+	1846 (122)		<.001
Occipital
Right	CMV−	1659 (224)	1731 (167)	.171
Right	CMV+	1723 (129)		.830
Left	CMV−	1675 (169)		.224
Left	CMV+	1725 (111)		.882

Table 4:

Comparison of ADC values between fetuses with CMV-positive infection and fetuses with isolated white matter hyperintense signal^{^a}

Lobe, Side	CMV-Positive	CMV-Negative	P Value
Frontal
Right	1872 (160)	1793 (192)	.147
Left	1858 (193)	1741 (141)	.026
Parietal
Right	1840 (140)	1659 (200)	.001
Left	1852 (138)	1690 (188)	.002
Temporal
Right	1835 (161)	1702 (169)	.011
Left	1846 (122)	1689 (193)	.002
Occipital
Right	1723 (129)	1659 (224)	.259
Left	1725 (111)	1675 (169)	.254

Table 5:

Delivery data, hearing, and VABS assessment^{^a}

Characteristic	CMV-Positive (n = 20)	CMV-Negative (n = 18)	P Value
Birth week	39.2 (38.5–39.9)	37.9 (39.7–40.6)	.55
Birth weight (percentile)	49 (31–73)	49 (13–68)	.53
Apgar score at 5 min ≥9	20 (100%)	18 (100%)	>.99
Hearing deficit^{^b}	1 (5%)	0 (0%)	>.99
Age (mo) at VABS test	30 (17–49)	27.5 (17.2–28.5)	.75
VABS motor skills	92.5 (81.75–104)	103 (95.25–108)	.07
VABS daily living skills	103 (99.25–117)	109 (99.25–117)	.28
VABS socialization	101 (98.5–105.75)	100 (96.75–115.75)	.89
VABS communication	107.5 (100.25–113)	108 (99.25–117)	.84
VABS adaptive score composite	102 (90–18)	107 (98–115)	.16
Child with any VABS score <70	4 (20%)	1 (5.5%)	.34

↵a Data are presented as median (interquartile range) for continuous variables or as number (percentage) for categoric variables.
↵b Hearing deficit was assessed by either transient evoked otoacoustic emissions or brain stem evoked potential.