Role of Ultrasound and Fetal MRI in the Prenatal Assessment of Congenital Cytomegalovirus Infection: A Systematic Review

Background: Congenital cytomegalovirus (CMV) infection is the most common congenital infection worldwide and a leading cause of neurodevelopment impairment. Prenatal imaging plays a central role in diagnosis and prognostic assessment. Methods: We conducted a systematic review of studies evaluating the role of ultrasound, including dedicated fetal neurosonography and magnetic resonance imaging (MRI) in the prenatal detection and assessment of CMV infection. PubMed, Web of Science, and Scopus were searched for relevant studies, and data were synthesized focusing on detected abnormalities and the incremental diagnostic value of MRI. Results: Fifty-nine studies were included. Dedicated neurosonography (NSG) was the primary modality for detecting CMV-related fetal brain abnormalities, particularly ventriculomegaly and cortical malformations. Fetal MRI provided additional diagnostic information, mainly through improved visualization of the brain parenchyma, allowing better detection of white matter abnormalities, migrational disorders and posterior fossa involvement, especially when performed later in gestation. Conclusions: Dedicated neurosonography remains the cornerstone for the evaluation of suspected congenital fetal CMV infection. Fetal MRI represents a complementary tool that can confirm, refine or extend ultrasound findings and may improve prognostic assessment when additional or subtle brain abnormalities are suspected.