Ultrasonography for the diagnosis of craniosynostosis

https://doi.org/10.1016/j.ejrad.2017.03.006Get rights and content

Highlights

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    Cranial US shows high accuracy in the diagnosis of craniosynostosis.

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    US may be the first-choice imaging in infants with skull deformity.

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    US is efficient in diagnose a partial or complete suture closure.

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    3D-CT may be secondary performed at the appropriate time before surgery.

Abstract

Objectives

The aim of this study was to report our experience with ultrasonography in our routine practice for the diagnosis of cranial deformity in infants.

Methods

We conducted a single-institution retrospective study of infants referred to our department because of skull deformity. We only included in this study infants having undergone both US and 3D-CT to ensure accurate comparisons. Each cranial suture was described as normal or closed (partial or complete closure). Sonography examination results were correlated with 3D-CT findings as a gold-standard.

Results

Forty infants were included with a mean age of 5.2 ± 4.9 months. Thirty had a craniosynostosis and 10 children had a postural deformity with normal sutures. Correlation between US and 3D-CT for the diagnosis of normal or closed suture had a specificity and a sensitivity of 100%. US examination for the diagnosis of complete or incomplete synostosis had a sensitivity of 100%.

Conclusions

Cranial US is an effective technique to make a positive or negative diagnosis of prematurely closed suture. US examination of sutures is a fast and non-radiating technique, which may serve as a first-choice imaging modality in infants with skull deformity.

Introduction

Cranial deformity is common in children. The 2 main causes remain positional plagiocephaly and craniosynostosis. Positional plagiocephaly is becoming more and more frequent since recommendations to place infants on their backs for sleeping in order to prevent sudden infant death syndrome. On the contrary, craniosynostosis caused by the premature closure of one or more sutures of the cranial bones is a much more uncommon condition occurring in only 3–6 infants per 10,000 live births [1]. Consequences of these 2 deformities may be very different as craniosynostosis may lead to severe chronic intracranial hypertension and thus need surgical correction. Differential diagnosis between these 2 malformations sometimes remains challenging. Although physical examination is sufficient to differentiate craniosynostosis and deformational plagiocephaly in most cases, cranial imaging is still regularly needed to confirm the diagnosis especially for non-specialized practitioners [1]. Conventional cranial X-ray has traditionally been the first imaging modality but its interpretation is particularly demanding and it is a source of radiation. Three-dimensional computed tomography (3D-CT) has high diagnosis accuracy, and is considered as the gold standard [2] but acquisition may need sedation and it is also a source of radiation. Very recently, ultrasonography (US) has been proposed to assist practitioners in the diagnosis of craniosynostosis with excellent efficiency [3], [4]. However, although US has multiple advantages such as low cost and non-ionising technique few studies have as yet been conducted [5], [6], [7], [8], [9], [10]. To date US is not yet considered as a screening tool for craniosynostosis.

The aim of this study was to report our experience with US in our routine practice for the diagnosis of cranial deformity in infants and to demonstrate its high accuracy in the diagnosis of craniosynostosis.

Section snippets

Study group

We conducted a single-institution retrospective study between 2004 and 2014 in our paediatric radiology department. During this period, infants that were referred to our department by a general practitioner or a paediatrician for skull deformity and suspicion of craniosynostosis underwent both a cranial US and a plain radiography or 3D-CT according to the practitioner’s prescription. Ultrasonography was performed in all cases by one of the paediatric radiologist from our department (CT, BB, KC

Study group description

A total of 40 infants were finally included. There were 7 girls and 33 boys. Thirty children had a craniosynostosis including 20 scaphocephaly, 4 trigonocephaly, 3 plagiocephaly, 2 brachycephaly, and 1 atypical craniosynostosis. The case of atypical craniosynostosis was one case with both sagittal and left coronal suture synostosis. Ten children had a postural deformity with normal sutures including 8 positional plagiocephaly and 2 nonsynostotic scaphocephaly. The mean age of the 40 children

Discussion

During recent years, the incidence of positional plagiocephaly in young children has increased by up to 20% [11] due to recommendations to position infants on their back [12]. Thus, it is now a frequent finding [13], [14]. In such cases, it is important to exclude craniosynostosis. Although diagnosis of positional plagiocephaly could be assessed by physical examination with some typical features such as trapezoidal head shape, mastoid bulge, tilt of the cranial base and pushed-forwards ear

Conclusion

US examination of sutures is a fast, effective and non-irradiating technique that may serve as a first choice imaging modality in infants (particularly under 8 months old) with skull deformity when craniosynostosis is suspected. In our study, we demonstrated that US was an effective technique for positive diagnosis of a prematurely closed suture. Diagnosis of craniosynostosis can be ruled out if US examination of the entire coronal, sagittal and lambdoid sutures demonstrates normal patent

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