Computed tomography and magnetic resonance imaging findings in infants with microcephaly potentially related to congenital Zika virus infection

The recent association between the increase in the number of neonates with microcephaly in northeastern Brazil and the outbreak of infection with the Zika virus, which has been occurring in the Americas, has been declared a public health emergency of international concern. The evidence that implicates the virus as the cause of this public health emergency has been demonstrated ever more consistently. This pictorial essay illustrates the imaging characteristics seen on computed tomography and magnetic resonance imaging scans of infants admitted to a rehabilitation hospital with a diagnosis of microcephaly and a maternal history of rash during pregnancy.

Keywords:
Microcephaly; Zika virus infection; Tomography, X-ray computed; Magnetic resonance imaging

Authorship

Aníbal Araujo Alves Peixoto FilhoMailing address: Dr. Aníbal Araujo Alves Peixoto Filho. Associação das Pioneiras Sociais - Setor de Radiologia. Avenida Tancredo Neves, 2782, Caminho das Árvores. Salvador, BA, Brazil, 41820-900. E-mail: anibalpeixotof@gmail.com.

MD, Specialist in Radiology and Diagnostic Imaging for the Rede Sarah de Hospitais de Reabilitação, Salvador, BA, Brazil.Rede Sarah de Hospitais de ReabilitaçãoBrazilSalvador, BA, BrazilMD, Specialist in Radiology and Diagnostic Imaging for the Rede Sarah de Hospitais de Reabilitação, Salvador, BA, Brazil.

Simone Baltar de Freitas

Márcio Morikoshi Ciosaki

Lourenço Nogueira e Oliveira

Onildo Tavares dos Santos Júnior

Mailing address: Dr. Aníbal Araujo Alves Peixoto Filho. Associação das Pioneiras Sociais - Setor de Radiologia. Avenida Tancredo Neves, 2782, Caminho das Árvores. Salvador, BA, Brazil, 41820-900. E-mail: anibalpeixotof@gmail.com.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (7)

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Figure 1
CT scan showing parenchymal calcifications in several locations in different patients. A: In the deep white matter and in cortical-subcortical regions, at the level of the corona radiata, assuming a confluent aspect. B: In cortical-subcortical regions, at the level of the lateral ventricles. C: Calcifications in the thalamus and in the capsulonuclear regions. Note the narrowing of the frontal bones, in A, and the small left frontal subcortical cyst, in B.

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Figure 2
MRI. A,B: Volumetric gradient-echo sequences showing foci of signal hypointensity in the cortical-subcortical regions, thalamic, and capsulonuclear regions. C: Volumetric fast spoiled gradient-echo T1-weighted sequence, of the same patient depicted in B, showing foci of signal hyperintensity, confluent in the cortical-subcortical regions, corresponding to the foci of signal hypointensity seen in the gradient-recalled echo sequence.

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Figure 3
MRI, T2-weighted sequences in different patients, showing a pattern of gyral simplification, accompanied by ventriculomegaly and enlargement of the subarachnoid spaces. In B, a subcortical cyst can be seen in the left frontal region, as can polymicrogyria, which is best visualized in the left temporoparietal region (arrow).

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Figure 4
MRI scan showing patterns of altered gyral morphology on the lissencephaly spectrum, characterized by smoother contours of the cortical surface and a certain thickening, with a more generalized presentation in A and an asymmetric presentation in B, with more pronounced pachygyria in the right frontal region.

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Figure 5
MRI: axial T2-weighted sequence (A) showing hypogenesis of the corpus callosum; and sagittal three-dimensional fast imaging employing steady-state acquisition sequence (B), showing more clearly the genu and body of the corpus callosum, both of which are hypoplastic.

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Figure 6
MRI: sagittal T1-weighted sequence (A) and coronal T2-weighted sequence (B), both showing agenesis of the corpus callosum. In A, note the craniofacial disproportion, occipital bone protuberance ("saddling"), skin folds, and caudal projection of the cerebellar tonsils. In B, note the high positioning of the third ventricle and the absence of the corpus callosum, as well as enlargement of the subarachnoid space, ventriculomegaly, and considerable reduction in the size of the telencephalon.

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Figure 7
MRI. A,B: Coronal T2-weighted sequence showing discrete hypoplasia of the right cerebellar hemisphere (in A) and relative prominence of the cerebellum in relation to the telencephalon (in B), as well as (in both) ventriculomegaly and a significant reduction in the volume of the white matter. C: Hypoplasia and rotation of the cerebellar vermis, accompanied by a prominent cerebrospinal fluid collection in the posterior fossa, as well as changes on the Dandy-Walker continuum. Note that there is also hypoplasia of the brainstem, notably of the pons.

Figure 1 CT scan showing parenchymal calcifications in several locations in different patients. A: In the deep white matter and in cortical-subcortical regions, at the level of the corona radiata, assuming a confluent aspect. B: In cortical-subcortical regions, at the level of the lateral ventricles. C: Calcifications in the thalamus and in the capsulonuclear regions. Note the narrowing of the frontal bones, in A, and the small left frontal subcortical cyst, in B.

Figure 2 MRI. A,B: Volumetric gradient-echo sequences showing foci of signal hypointensity in the cortical-subcortical regions, thalamic, and capsulonuclear regions. C: Volumetric fast spoiled gradient-echo T1-weighted sequence, of the same patient depicted in B, showing foci of signal hyperintensity, confluent in the cortical-subcortical regions, corresponding to the foci of signal hypointensity seen in the gradient-recalled echo sequence.

Figure 3 MRI, T2-weighted sequences in different patients, showing a pattern of gyral simplification, accompanied by ventriculomegaly and enlargement of the subarachnoid spaces. In B, a subcortical cyst can be seen in the left frontal region, as can polymicrogyria, which is best visualized in the left temporoparietal region (arrow).

Figure 4 MRI scan showing patterns of altered gyral morphology on the lissencephaly spectrum, characterized by smoother contours of the cortical surface and a certain thickening, with a more generalized presentation in A and an asymmetric presentation in B, with more pronounced pachygyria in the right frontal region.

Figure 5 MRI: axial T2-weighted sequence (A) showing hypogenesis of the corpus callosum; and sagittal three-dimensional fast imaging employing steady-state acquisition sequence (B), showing more clearly the genu and body of the corpus callosum, both of which are hypoplastic.

Figure 6 MRI: sagittal T1-weighted sequence (A) and coronal T2-weighted sequence (B), both showing agenesis of the corpus callosum. In A, note the craniofacial disproportion, occipital bone protuberance ("saddling"), skin folds, and caudal projection of the cerebellar tonsils. In B, note the high positioning of the third ventricle and the absence of the corpus callosum, as well as enlargement of the subarachnoid space, ventriculomegaly, and considerable reduction in the size of the telencephalon.

Figure 7 MRI. A,B: Coronal T2-weighted sequence showing discrete hypoplasia of the right cerebellar hemisphere (in A) and relative prominence of the cerebellum in relation to the telencephalon (in B), as well as (in both) ventriculomegaly and a significant reduction in the volume of the white matter. C: Hypoplasia and rotation of the cerebellar vermis, accompanied by a prominent cerebrospinal fluid collection in the posterior fossa, as well as changes on the Dandy-Walker continuum. Note that there is also hypoplasia of the brainstem, notably of the pons.

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Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

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Computed tomography and magnetic resonance imaging findings in infants with microcephaly potentially related to congenital Zika virus infection

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[1] Mailing address: Dr. Aníbal Araujo Alves Peixoto Filho. Associação das Pioneiras Sociais - Setor de Radiologia. Avenida Tancredo Neves, 2782, Caminho das Árvores. Salvador, BA, Brazil, 41820-900. E-mail: anibalpeixotof@gmail.com.