Neuroimaging Abnormalities in Congenital Cytomegalovirus Infection: A Systematic Review and Pooled Descriptive Analysis.

Congenital cytomegalovirus (cCMV) is the most common congenital viral infection and an important cause of neurological morbidity, yet reported neuroimaging findings vary across studies and imaging modalities. We performed a systematic review with pooled descriptive analysis to characterize neuroimaging abnormalities reported in cCMV. PubMed, Scopus, and Embase were searched for English-language, peer-reviewed studies published from January 1, 2013, through December 1, 2024, that reported extractable prenatal or postnatal neuroimaging data in confirmed cCMV. Studies using magnetic resonance imaging (MRI), cranial ultrasound (US), and/or computed tomography (CT) were eligible. After source-type cleaning and reference-to-extraction audit, 63 original studies met review eligibility. To reduce the influence of single-case reports and very small case series, the primary quantitative analysis excluded reports with fewer than five cCMV cases and included 50 studies contributing 5742 neuroimaging examinations: 2739 MRI; 2802 US; and 201 CT. Overall, 2653 examinations were abnormal (46.2%), including 51.7% of MRI, 40.7% of US, and 47.8% of CT examinations. Among examinations eligible for feature-specific reporting, the most frequently reported pooled findings were white matter abnormalities (1016/3294, 30.8%), cystic abnormalities (614/2974, 20.6%), ventriculomegaly or ventricular asymmetry (460/2898, 15.9%), lenticulostriatal vasculopathy (345/2307, 15.0%), and calcifications (343/3090, 11.1%). Modality-specific differences were observed: calcifications were most frequently reported on CT, lenticulostriatal vasculopathy on US, and white matter abnormalities on MRI. These findings are consistent with a staged, complementary imaging approach in cCMV but should be interpreted as reported examination-level frequencies rather than true biological prevalence estimates.