Bildgebende Darstellung einer Zytomegalievirusinfektion des kindlichen zentralen Nervensystems

Zusammenfassung

Das CMV (Zytomegalievirus) ist ein ubiquitäres Virus, das üblicherweise zu einer asymptomatischen oder klinisch harmlosen Infektion führt. Allerdings gibt es 2 Patientengruppen, deren Reaktion auf eine CMV-Infektion erheblich schwerwiegender ausfällt: Patienten mit intrauteriner Infektion und Patienten mit Immunschwäche. Zwar unterscheiden sich die Manifestationen dieser Arten der Infektion, aber beide haben häufig beträchtliche neurologische Folgen. Die Bildgebung spielt eine Schlüsselrolle bei der Diagnose kongenitaler und erworbener CMV-Infektionen. Zu den neurologischen Befunden einer kongenitalen CMV-Infektion gehören intrakranielle Verkalkungen, Migrationsanomalien, Volumenverlust in Hirn und Kleinhirn, Ventrikulomegalie und Erkrankung der weißen Substanz. Bei Kindern mit neurologischen Entwicklungsverzögerungen deuten solche Befunde auf eine kongenitale CMV-Infektion hin, selbst wenn das Kind bei der Geburt keine Symptome zeigte. Bestimmte Merkmale der Bildgebung können auch auf zukünftige neurologische Defizite bei symptomatischen Säuglingen hinweisen. Eine erworbene CMV-Infektion ist potenziell tödlich bei immungeschwächten Patienten, die eine HIV-Infektion oder AIDS haben oder bei denen eine Organ- oder Knochenmarktransplantation vorgenommen wurde. Die Zeichen der Bildgebung bei erworbener CMV-Infektion sind oft unspezifisch, können aber auf die Notwendigkeit einer weiteren serologischen Untersuchung zur Feststellung einer CMV-Infektion hinweisen. Eine frühe Diagnose und Behandlung einer CMV-Infektion des ZNS sind von entscheidender Bedeutung für eine effektive Therapie. Voraussetzung für eine präzise Diagnose dieser häufigen Infektion ist die Vertrautheit mit ihren Zeichen in der Bildgebung.

Abstract

Cytomegalovirus (CMV) is a ubiquitous virus that usually results in asymptomatic or clinically benign infection. However, there are two groups of patients whose response to CMV infection is much more severe: those who are infected during fetal development and those who are immunocompromised. Although the manifestations of these types of infection differ, both often result in substantial neurologic sequelae. Imaging plays a key role in the diagnosis of both congenital and acquired CMV infection. Neurologic findings of congenital CMV infection include intracranial calcification, migrational abnormalities, cerebral and cerebellar volume loss, ventriculomegaly, and white matter disease. The presence of these fi ndings in children with neurodevelopmental delays is suggestive of congenital CMV infection, even if the child was asymptomatic at birth. Certain imaging features also may indicate future neurologic deficits in symptomatic infants. Acquired CMV infection is potentially deadly in immunocompromised patients such as those infected with human immunodeficiency virus or with acquired immune deficiency syndrome and those with a history of solid organ or bone marrow transplantation. Imaging findings of acquired CMV infection often are nonspecific; however, they may indicate a need for further serologic analysis to determine if CMV infection is present. Early recognition and treatment of central nervous system CMV infection is vital for effective treatment, and familiarity with the imaging findings of this common infection is important for accurate diagnosis.

1 © 2010 The Radiological Society of North America. All rights reserved. Originally published in English in RadioGraphics 2010; 30: 1779 – 1796. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.

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1 © 2010 The Radiological Society of North America. All rights reserved. Originally published in English in RadioGraphics 2010; 30: 1779 – 1796. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.