{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T21:50:39Z","timestamp":1791409839235,"version":"4.3.3"},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T00:00:00Z","timestamp":1720483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100024250","name":"Israel Innovation Authority","doi-asserted-by":"publisher","award":["72126"],"award-info":[{"award-number":["72126"]}],"id":[{"id":"10.13039\/501100024250","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100024250","name":"Israel Innovation Authority","doi-asserted-by":"publisher","award":["79264"],"award-info":[{"award-number":["79264"]}],"id":[{"id":"10.13039\/501100024250","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Magnetic Resonance Imaging"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Cytomegalovirus (CMV) is the most common intrauterine infection and may be associated with unfavorable outcomes. While some CMV\u2010infected fetuses may show gross or subtle brain abnormalities on MRI, their clinical significance may be unclear. Conversely, normal development cannot be guaranteed in CMV\u2010infected fetuses with normal MRI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To assess brain metabolite differences in CMV\u2010infected fetuses using magnetic resonance spectroscopy (MRS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study type<\/jats:title><jats:p>Retrospective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects<\/jats:title><jats:p>Out of a cohort of 149 cases, 44 with maternal CMV infection, amniocentesis results, and good\u2010quality MRS were included. CMV\u2010infected fetuses with positive polymerase chain reaction (PCR) (<jats:italic>N<\/jats:italic>\u2009=\u200935) were divided based on MRI results as follows: typical brain abnormalities (gross findings, <jats:italic>N<\/jats:italic>\u2009=\u20098), exclusive white matter hyperintense signal (WMHS) on T<jats:sub>2<\/jats:sub>\u2010weighted images (subtle findings, <jats:italic>N<\/jats:italic>\u2009=\u20097), and normal MRI (<jats:italic>N<\/jats:italic>\u2009=\u200920). Uninfected fetuses (negative PCR) with normal MRI were included as controls (<jats:italic>N<\/jats:italic>\u2009=\u20099).<\/jats:p><\/jats:sec><jats:sec><jats:title>Field Strength<\/jats:title><jats:p>3\u2009T, T<jats:sub>2<\/jats:sub>\u2010weighted half Fourier single\u2010shot turbo spin\u2010echo (HASTE), T<jats:sub>2<\/jats:sub>\u2010weighted true fast imaging with steady\u2010state free precession (TrueFISP), T<jats:sub>1<\/jats:sub>\u2010 and T<jats:sub>2<\/jats:sub>*\u2010weighted fast low angle shot (FLASH), and <jats:sup>1<\/jats:sup>H\u2010MRS single\u2010voxel point resolved spectroscopy (PRESS) sequences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Assessment<\/jats:title><jats:p>MRI findings were assessed by three radiologists, and metabolic ratios within the basal ganglia were calculated using LCModel.<\/jats:p><\/jats:sec><jats:sec><jats:title>Statistical Tests<\/jats:title><jats:p>Analysis of covariance test with Bonferroni correction for multiple comparisons was used to compare metabolic ratios between groups while accounting for gestational age. A <jats:italic>P<\/jats:italic>\u2010value &lt;0.05 was deemed significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>MRS was successfully acquired in 63% of fetuses. Substantial agreement was observed between radiologists (Fleiss' kappa [<jats:italic>k<\/jats:italic>]\u2009=\u20090.8). Infected fetuses with gross MRI findings exhibited significantly reduced tNAA\/tCr ratios (0.64\u2009\u00b1\u20090.08) compared with infected fetuses with subtle MRI findings (0.85\u2009\u00b1\u20090.19), infected fetuses with normal MRI (0.8\u2009\u00b1\u20090.14) and controls (0.81\u2009\u00b1\u20090.15). No other significant differences were detected (<jats:italic>P<\/jats:italic>\u2009\u2265\u20090.261).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Reduced tNAA\/tCr within the apparently normal brain tissue was detected in CMV\u2010infected fetuses with gross brain abnormalities, suggesting extensive brain damage. In CMV\u2010infected fetuses with isolated WMHS, no damage was detected by MRS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>3<\/jats:p><\/jats:sec><jats:sec><jats:title>Technical Efficacy<\/jats:title><jats:p>Stage 3<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmri.29507","type":"journal-article","created":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T11:54:19Z","timestamp":1720526059000},"page":"1133-1141","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Brain Metabolite Differences in Fetuses With Cytomegalovirus Infection: A Magnetic Resonance Spectroscopy Study"],"prefix":"10.1002","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2054-9679","authenticated-orcid":false,"given":"Or R.","family":"Sadan","sequence":"first","affiliation":[{"name":"Sagol Brain Institute Tel Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"},{"name":"Sagol School of Neuroscience Tel\u2010Aviv University  Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0719-1327","authenticated-orcid":false,"given":"Netanell","family":"Avisdris","sequence":"additional","affiliation":[{"name":"Sagol Brain Institute Tel Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"},{"name":"School of Computer Science and Engineering The Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9406-6523","authenticated-orcid":false,"given":"Aviad","family":"Rabinowich","sequence":"additional","affiliation":[{"name":"Sagol Brain Institute Tel Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"},{"name":"Department of Radiology Tel Aviv Sourasky Medical Center  Tel\u2010Aviv Israel"},{"name":"Faculty of Medical &amp; 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