US finds brain differences in infants exposed to Zika virus

By Amerigo Allegretto, AuntMinnie.com staff writer

July 6, 2021 -- Cranial ultrasound found lenticulostriate vasculopathy to be more common in infants exposed to the mosquito-borne Zika virus, according to research from Brazil published June 29 in Radiology.

A team of researchers led by Sara Reis Teixeira, PhD, from the University of São Paulo found that lenticulostriate vasculopathy, a cranial ultrasound finding related to pre- or perinatal brain injury, was 9 times more frequent in infants exposed to the Zika virus infants compared with otherwise healthy infants.

"Our results demonstrate a spectrum of neuroimaging findings in a large cohort of infants born to infected pregnant women and support recent guidelines in recommending postnatal cranial ultrasound for all infants with possible congenital Zika virus infection, regardless of the presence of microcephaly," the study authors said.

Zika virus infection during pregnancy may lead to a wide range of central nervous system changes, the researchers said. While most previous studies have assessed patients who are severely affected, such as having microcephaly, there is little information on abnormalities in infants with normal head size.

The investigators wanted to find out the prevalence of cranial ultrasound findings in a large group of infants born to women with Zika virus infection with infants born to mothers not infected. They also wanted to study signs of prenatal Zika virus exposure on cranial ultrasound scans, looking at infants from the 2015-2016 Zika virus outbreak in southeast Brazil.

"Neuroimaging is a fundamental component of the diagnostic evaluation of infants at risk for congenital Zika virus syndrome," the study authors wrote. "Information regarding the spectrum of brain findings in a large cohort of infants born to infected women is still scarce."

The study included 220 infants exposed to the Zika virus, with an average age of 53.3 days. Of these, 113 were boys and 107 were girls. Meanwhile, 170 infants with an average age of 45.6 days (102 boys, 68 girls) who were not exposed to the virus were in a control group.

Cranial ultrasound found a Zika virus-like pattern in 11 of the 220 virus-exposed infants, but not in the control group infants.

Calcifications and subcortical calcifications were found only in Zika-exposed infants. Other intracranial calcifications, such as those in the basal ganglia, periventricular area, and scattered in the brain, were also associated with virus exposure. However, the frequency of most mild cranial ultrasound findings was not significantly different between both groups.

However, the finding of lenticulostriate vasculopathy was found in 12 of the virus-exposed infants, while being found in only one infant in the control group (p = 0.01).

The team said that further studies are needed to evaluate the potential clinical significance of lenticulostriate vasculopathy and other mild cranial ultrasound findings in infants exposed to Zika virus.

An accompanying editorial written by Dr. Carol Benson from Harvard Medical School said that long-term neurodevelopmental outcomes in infants exposed to the virus in utero are also needed to determine how best to counsel patients exposed while pregnant, as well as to understand the clinical significance of mild sonographic abnormalities in infants.

Short US screening intervals improve liver cancer outcomes

By Amerigo Allegretto, AuntMinnie.com staff writer

June 25, 2021 -- Ultrasound screenings with shorter intervals for high-risk patients with hepatocellular carcinoma (HCC) may save more lives and improve quality of life, according to research published June 24 in JAMA Network Open.

The results suggest a relatively easy way to improve HCC patient outcomes, wrote a team led by Dr. Shih-Chiang Kuo from the National Cheng Kung University Hospital in Taiwan.

"Our finding shows a clear indication of saving life-years and quality of life, and clinicians can use this knowledge to remind their patients, especially those with viral infection and/or cirrhosis of liver," said Dr. Jung-Der Wang, one of the study's co-authors.

Hepatocellular carcinoma accounts for most liver cancer cases. But despite improvements in medical technology and treatment, the five-year survival rate of HCC remains low, according to Kuo's team.

Early detection by screening is recommended by medical societies, but some research does not support six-month screening intervals using abdominal ultrasonography. Along with that, an "inadequate" number of high-risk patients do not adhere to regular screenings, the authors noted.

"Many patients with viral hepatitis B or C infection, or, cirrhosis of liver might feel tired of such examinations after negative results of the initial several years," Wang told AuntMinnie.com. "Then, many of them would consider that they might not be the unlucky one who would later develop HCC and stop the biannual screening ultrasonography."

Kuo and colleagues sought to investigate the optimal interval of ultrasonography screening for early diagnosis of HCC among high-risk patients via a study that included 59,194 patients; of these, 42,081 were men (average age, 62.2 years) and 17,113 were women (average age, 69).

The team found the longer the interval between ultrasonography screenings, the higher the loss of life expectancy and loss of quality-adjusted life expectancy for both men and women.

Loss of quality-adjusted life years by ultrasound screening interval period in patients with HCC
Gender	6 months	12 months	24 months	36 months	More than 36 months
Men	10	11.1	12.1	13.1	14.6
Women	9	9.7	10.3	10.7	11.4

The authors also noted that patients with underlying hepatitis B virus infection or cirrhosis had the greatest improvement in life expectancy with shorter screening intervals.

Although multiple medical societies recommend ultrasonography screening for HCC every six to 12 months, the researchers found that only 31.4% of men and 42.2% of women with HCC in Taiwan underwent ultrasonography within six months before diagnosis, and only 39.3% of men and 51.9% of women underwent such screening within 12 months.

"Moreover, among those with underlying liver cirrhosis, only 35.5% of men and 49.1% of women underwent ultrasonography within six months before HCC diagnosis, indicating underutilization of ultrasonography screening in Taiwan," the team wrote.

The study highlights the fact that use of ultrasound for early detection of HCC could be improved, according to the authors.

"The results of this study suggest that regular ultrasonography screening with an interval of six to 12 months or less may lead to early detection of HCC and may save lives and improve utility for patients with HCC from a lifetime perspective," they concluded. "Because people with underlying risk factors ... showed only slightly more frequent ultrasonography screening than those without ... we recommend improving this clinical practice."

Wang told AuntMinnie.com that the team is looking into what even more frequent screening, namely three months, would do for patients, as well as the cost-effectiveness of such screening in terms of cost per quality-adjusted life-year saved.