Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Kyriakopoulou Aikaterini
Dissertation committee:
Παπαευαγγέλου Βασιλική, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ψαλτοπούλου Θεοδώρα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αντωνιάδου Αναστασία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αλεξοπούλου Ευθυμία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ντινόπουλος Αργύριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κανακά-Gantenbein Χριστίνα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αργυροπούλου Μαρία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ Πανεπιστήμιο Ιωαννίνων
Original Title:
Διερεύνηση συσχέτισης LSV και cCMV λοίμωξης σε πρόωρα νεογνά
Translated title:
Association between LSV and cCMV infection in preterm neonates
Summary:
Congenital Cytomegalovirus (cCMV) infection has a global prevalence ranging from 0.2% to 2.5%. Despite its status as the most common congenital infection associated with various neurodevelopmental issues, the absence of screening programs leads to a significant number of undiagnosed neonates, missing timely intervention opportunities. This thesis aims to identify neuroimaging biomarkers of cCMV at birth to enable early diagnosis and identification of high-risk newborns who would benefit from antiviral therapy and intensive follow-up. Subsequently, the implementation of targeted neonatal screening programs in Greece will be discussed. A systematic review and meta-analysis were initially conducted to evaluate the predictive capability of prenatal imaging modalities (MRI and/or US) in determining clinical outcomes in cCMV. Despite challenges in interpreting the heterogeneous findings across studies, a significant observation was the high negative predictive value of normal fetal US and MRI for adverse outcomes in cCMV-infected fetuses. Fetal microcephaly exhibited a strong correlation with neurodevelopmental impairment.
The comparison between neonatal and fetal imaging was then explored. Neonatal MRI is commonly recommended when abnormalities are detected on fetal or neonatal ultrasound to identify relevant cerebral anomalies and predict long-term neurological sequelae. However, limitations related to accessibility, cost, and sedation hinder its widespread use. Conversely, fetal MRI, a less invasive procedure performed during the prenatal stage, allows more time for decision-making. In a retrospective cohort study involving 10 asymptomatic neonates with congenital CMV infection who underwent both fetal and neonatal MRI scans, preliminary findings suggested that fetal MRI could provide comparable information to neonatal imaging. The lack of specificity of US abnormalities associated with cCMV presents a significant challenge as many of these findings are also observed in other pathologies. Therefore, identifying a cerebral abnormality specific to cCMV is crucial. Lenticulostriate vasculopathy (LSV), a recently discovered cerebral abnormality, has been investigated in relation to CMV. We conducted a prospective case-control study of 163 neonates (83 cases: 83 controls) to examine the role of LSV and prematurity as imaging biomarkers for cCMV infection. Overall, our results demonstrated that LSV was not significantly associated to cCMV. Furthermore neonates with LSV had significantly larger z-head circumference, z-weight and more commonly depicted other concomitant cerebral abnormalities. Severe LSV, was further associated with LGA (large for gestational age) neonates and abnormal head circumference (above or below 2 SD from mean of z-score HC). Larger studies are needed to establish the relevance of these findings.
Main subject category:
Health Sciences
Keywords:
Congenital infections, CMV, LSV, Neuroimaging, Biomarkers
Number of references:
253
