Purpose or Case Report: Neonatal and perinatal infections pose diagnostic challenges due to nonspecific clinical presentations, necessitating prompt neuroimaging to guide management and predict outcomes. We aim to review the spectrum of imaging findings in congenital, perinatal, and postnatal infections affecting the central nervous system (CNS) in neonates. By illustrating characteristic patterns, we seek to establish a systematic approach for radiologists to narrow differentials, recognize complications, and facilitate multidisciplinary care.
Methods & Materials: This pictorial review synthesizes current literature and illustrative cases from institutional archives, including fetal and neonatal neuroimaging from several confirmed infections. Modalities encompass ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).
Results: Imaging patterns vary by pathogen, timing, and CNS maturity, with overlaps but distinguishing features. Early in-utero infections yield severe malformations; later ones show milder changes.
-CMV: US shows periventricular calcifications, ventriculomegaly, subependymal cysts. Fetal MRI reveals T2-hyperintense temporal lesions, smudgy cortex, cerebellar hypoplasia; postnatal MRI/ CT adds polymicrogyria, hemorrhages.
-Toxoplasmosis: Hydrocephalus, calcifications (peripheral/ basal ganglia), porencephaly. MRI/CT distinguish peripheral vs. CMV's periventricular pattern.
-Rubella: Microcephaly, ventriculomegaly, white matter hyperintensities, polymicrogyria, cerebellar hypoplasia. CT highlights periventricular/ basal ganglia calcifications.
-HSV: Asymmetric temporal-insular diffusion restriction (DWI), evolving to encephalomalacia/ gliosis. US shows hyperechogenicity.
-Emerging (Zika, Parechovirus, SARS-CoV-2): Zika: Corticomedullary calcifications, microcephaly, polymicrogyria. Parechovirus: Bilateral white matter restricted diffusion (deep medullary veins), cystic encephalomalacia. SARS-CoV-2: Periventricular leukomalacia, hemorrhages from placental compromise.
Conclusions: Multimodal neuroimaging is pivotal for diagnosing perinatal/ neonatal CNS infections, differentiating pathogens via pattern recognition (e.g. calcification location), and prognosticating sequelae like developmental delay. Early intervention via radiology-clinician collaboration improves outcomes.