Marjo S. van der Knaap, MD, PhD Gerre Vermeulen Frederik Barkhof, MD, PhD Augustinus A. M. Hart, MSc J. Gerard Loeber, PhD Jan F. L. Weel, MD, PhD Index terms: Brain, diseases, 10.8721 Brain, MR, 10.12141 Brain, white matter, 10.2066 Infants, central nervous system, 10.8721 Magnetic resonance (MR), in infants and children, 10.12141 Viruses, 10.2066 Published online 10.1148/radiol.2302021459 Radiology 2004; 230:529 –536 Abbreviations: CMV = cytomegalovirus PCR = polymerase chain reaction 1 From the Departments of Child Neu- rology (M.S.v.d.K., G.V.) and Radiol- ogy (F.B.), Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Depart- ments of Clinical Epidemiology and Biostatistics (A.A.M.H.) and Medical Microbiology (J.F.L.W.), Academic Medical Center, Amsterdam, the Netherlands; and Diagnostic Labora- tory for Infectious Diseases and Perina- tal Screening, National Institute for Public Health, Bilthoven, the Nether- lands (J.G.L.). Received November 6, 2002; revision requested January 15, 2003; final revision received June 10; accepted August 6. Address corre- spondence to M.S.v.d.K. (e-mail: ms.vanderknaap@vumc.nl). Author contributions: Guarantor of integrity of entire study, M.S.v.d.K.; study concepts, M.S.v.d.K., A.A.M.H., J.F.L.W.; study design, M.S.v.d.K., J.F.L.W.; literature re- search, M.S.v.d.K., J.F.L.W.; clinical studies, M.S.v.d.K., F.B.; experimen- tal studies, G.V., J.F.L.W., J.G.L.; data acquisition, M.S.v.d.K., G.V., F.B., J.G.L.; data analysis/interpretation, M.S.v.d.K., J.F.L.W., F.B.; statistical analysis, A.A.M.H.; manuscript prep- aration, M.S.v.d.K., F.B., A.A.M.H., J.F.L.W.; manuscript definition of in- tellectual content, M.S.v.d.K.; manu- script editing and final version ap- proval, M.S.v.d.K., F.B.; manuscript revision/review, all authors © RSNA, 2004 Pattern of White Matter Abnormalities at MR Imaging: Use of Polymerase Chain Reaction Testing of Guthrie Cards to Link Pattern with Congenital Cytomegalovirus Infection 1 PURPOSE: To define a magnetic resonance (MR) imaging pattern suggestive of congenital cytomegalovirus (CMV) infection by using polymerase chain reaction (PCR) testing to detect CMV DNA in neonatal blood on Guthrie cards for validation. MATERIALS AND METHODS: On the basis of findings in eight patients with documented congenital CMV infection, the authors developed MR imaging inclu- sion criteria, including multifocal lesions predominantly located in the deep parietal white matter. If gyral abnormalities were present, white matter lesions were either multifocal or diffuse. The criteria were applied to 152 patients with static leukoen- cephalopathy of unknown etiology. Guthrie cards for 22 of the 43 patients fulfilling the MR imaging criteria, 20 patients not fulfilling them, and 300 control subjects were analyzed. Fisher exact testing was used to evaluate the association between MR imaging characteristics and CMV status, and backward elimination linear dis- criminant analysis was used to identify MR imaging characteristics predictive of CMV infection in addition to the initial criteria. RESULTS: PCR test results were positive in 12 of 22 patients suspected of having congenital CMV infection, in no patient not suspected of having infection (P  .001), and in two of 300 control subjects (negative predictive value [NPV] of MR imaging criteria, 100% [95% CI: 83%, 100%]; positive predictive value [PPV], 55% [95% CI: 32%, 76%]). The most important additional MR imaging finding predict- ing a positive PCR result was abnormality of the anterior part of the temporal lobe, including abnormal white matter, cysts, and enlargement of inferior horns. Includ- ing this finding in the MR imaging criteria enhanced the PPV (89%; 95% CI: 52%, 99%) at the expense of the NPV (88%; 95% CI: 72%, 97%). CONCLUSION: In patients with static encephalopathy, an MR imaging pattern of multifocal lesions predominantly involving deep parietal white matter, with or without gyral abnormalities, is predictive of congenital CMV infection. When gyral abnormalities are present, leukoencephalopathy may also be diffuse. The presence of abnormalities in the anterior part of the temporal lobe increases the likelihood that CMV infection is present. © RSNA, 2004 White matter disorders of unknown etiology constitute a considerable problem in pedi- atric neurology (1,2). Children with neurologic deficits frequently are observed to have white matter abnormalities at magnetic resonance (MR) imaging. These abnormalities are Pediatric Imaging 529 R adiology