Diagnostic Yield of Cervical Radiographs in Infants with Deformational Plagiocephaly
Min-Jeong Cho1, Loa L Borchert, Nancy Rollins
1Dallas, Texas From the Departments of Plastic Surgery and Radiology, University of Texas Southwestern Medical Center; and Children's Medical Center.
Insights
Cervical spine radiographs in infants with deformational plagiocephaly and torticollis have a low diagnostic yield. Routine use of these imaging studies may not be warranted due to low abnormality detection rates.
Area of Science:
- Pediatric Radiology
- Orthopedics
- Neurosurgery
Background:
- Infants with deformational plagiocephaly often undergo cervical spine radiography to rule out anomalies causing torticollis.
- The diagnostic value of these radiographs in this specific patient group has not been previously assessed.
Purpose of the Study:
- To evaluate the diagnostic yield of cervical spine radiographs in infants presenting with deformational plagiocephaly and torticollis.
Main Methods:
- Retrospective review of 730 infants with deformational plagiocephaly and torticollis who underwent cervical radiography between 2010 and 2012.
- Radiology reports were reviewed, and a pediatric neuroradiologist re-evaluated studies with reported abnormalities.
- Patient data and physical examination findings were collected for descriptive statistical analysis.
Main Results:
- Only 6.7% of cervical radiography reports (49 of 730) indicated an abnormality.
- Abnormalities included osseous (47%), nonosseous (41%), or both (12%).
- Follow-up imaging confirmed true upper cervical spine anomalies in only three infants.
Conclusions:
- Cervical spine radiography demonstrates a low diagnostic yield for most infants with deformational plagiocephaly.
- Routine use of cervical radiographs in this population may not be cost-effective or necessary, despite low radiation exposure.
Background:
When evaluating infants with deformational plagiocephaly, cervical spine radiographs are often acquired along with skull radiographs to exclude segmentation and fusion anomalies as the cause of associated torticollis. The diagnostic yield of cervical spine radiographs has not been evaluated in this clinical setting.
Methods:
The authors retrospectively reviewed the charts of all patients who were referred to the University of Texas Southwestern School of Medicine, Children's Medical Center (Dallas, Texas) with deformational plagiocephaly and torticollis and underwent cervical radiography (anteroposterior and lateral views) from 2010 to 2012. The authors reviewed the radiology reports, and a single experienced pediatric neuroradiologist again reviewed all radiographic studies in which the interpreting radiologist had suggested any bony or soft-tissue abnormality. Patient demographics, perinatal data, and physical examination findings were collected, and descriptive statistics were calculated.
Results:
There were 730 patients with deformational plagiocephaly and torticollis; 49 of 730 reports (6.7 percent) described an abnormality. Of those with abnormal radiologic reports that were abnormal, 23 (47 percent) described osseous abnormalities, 20 (41 percent) described nonosseous deformities, and six (12 percent) described both. Follow-up studies (computed tomography, magnetic resonance imaging, and repeated radiography) of those with abnormalities showed three infants with true upper cervical spine anomalies that might lead to instability of the cervical spine.
Conclusions:
There is a low diagnostic yield in ordering cervical radiographs in most patients with deformational plagiocephaly. Although the radiation exposure is low, cervical radiographs add additional cost and may not be warranted as a routine practice in this clinical setting.
Clinical Question/Level Of Evidence:
Diagnostic, IV.
