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Children with macrocrania: clinical and imaging predictors of disorders requiring surgery
L S Medina1, K Frawley, D Zurakowski
1Health Outcomes and Policy Section, Radiology Outcomes Center, Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Macrocrania in children often requires neuroimaging to distinguish surgical from medical conditions. Combining clinical and imaging predictors offers the highest accuracy in guiding treatment decisions for pediatric macrocrania.
Area of Science:
- Pediatric Neurology
- Medical Imaging
- Clinical Diagnostics
Background:
- Macrocrania affects up to 5% of pediatric patients.
- Accurate differentiation is crucial for appropriate management.
Purpose of the Study:
- To identify clinical and imaging predictors for differentiating surgical from medical conditions in children with macrocrania.
- To enhance diagnostic performance in pediatric macrocrania cases.
Main Methods:
- Retrospective study of 88 pediatric patients with macrocrania.
- Utilized brain sonography, CT, and MR imaging.
- Correlated clinical and imaging data with final diagnoses using logistic regression and ROC curves.
Main Results:
- 18% of patients required surgery for conditions like hydrocephalus, subdural collections, or neoplasms.
- Clinical predictors included vomiting, developmental delay, and abnormal neurologic findings.
- Imaging predictors included focal space-occupying lesions and ventriculomegaly.
- Combined clinical and imaging predictors achieved 100% diagnostic sensitivity.
Conclusions:
- Baseline neuroimaging is essential for children with macrocrania.
- The combination of clinical and imaging predictors provides optimal diagnostic performance.
- This approach effectively guides surgical versus nonsurgical management decisions.
Background And Purpose:
Macrocrania is a common pediatric clinical condition affecting up to 5% of the population. The purpose of this study was to determine clinical and imaging predictors that are useful in the differentiation of disorders requiring surgical treatment from those that can be treated medically in children with macrocrania.
Methods:
In a 3-year 7-month retrospective study, 88 patients (median age, 8 months; interquartile range, 5--13 months) with macrocrania and no known underlying neurologic disorder underwent imaging of the brain (sonography, n = 36; CT, n = 31; MR imaging = 21). The study was conducted in a pediatric tertiary care referral center. Clinical and imaging data were correlated to final diagnosis by means of logistic regression and receiver operating characteristic curves.
Results:
Sixteen (18%) of the patients had disorders requiring surgery: communicating hydrocephalus, n = 7; noncommunicating hydrocephalus, n = 3; hemorrhagic subdural collections, n = 3; neoplasm, n = 1; encysted cavum septi pellucidi, n = 1; and vein of Galen malformation, n = 1. Clinical predictors of disorders requiring surgery included vomiting (P =.007), labor instrumentation (P =.026), developmental delay (P =.008), and abnormal neurologic findings (P =.028). Imaging predictors of disorders requiring surgery included a focal space-occupying lesion (P <.0001) and moderate-to-severe ventriculomegaly (P <.0001). The diagnostic sensitivity of the combination of independent clinical and imaging predictors was higher than that of independent clinical predictors alone, being 100% (95% confidence interval = 96.9%, 100%) and 93.8% (95% confidence interval = 88.7%, 98.8%), respectively. A trend indicated that the area under the receiver operating characteristic curve for clinical plus imaging findings (0.95) was greater than that for clinical findings alone (0.85) (P =.09). An increase in the number of clinical and imaging predictors was highly correlated with an increased risk of a disorder requiring surgery (P <.0001).
Conclusion:
Baseline neuroimaging is indicated for children with macrocrania because the combination of clinical and imaging predictors has the best diagnostic performance in determining the need for surgical versus nonsurgical management.
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