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State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Cranial Ultrasound as a First-Line Imaging Examination for Craniosynostosis
Katya Rozovsky1, Kristin Udjus2, Nagwa Wilson2
1Department of Medical Imaging, and Department of Diagnostic Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel katro70@yahoo.com.
Insights
Cranial ultrasound (CUS) is a safe and accurate first-line tool for diagnosing craniosynostosis in infants, reducing the need for radiation exposure from radiography. Metopic suture assessment may require further evaluation.
Area of Science:
- Pediatric Radiology
- Medical Imaging
- Craniosynostosis Diagnosis
Background:
- Craniosynostosis diagnosis often relies on radiography, involving ionizing radiation exposure for infants.
- Cranial ultrasound (CUS) offers a radiation-free alternative for imaging assessment.
Purpose of the Study:
- To compare the diagnostic accuracy of CUS versus radiography for craniosynostosis.
- To evaluate CUS as a potential first-line imaging modality.
Main Methods:
- Prospective study of 126 infants (0-12 months) assessed for craniosynostosis.
- Independent, blinded interpretation of 4-view skull radiography and CUS by two pediatric radiologists.
- Analysis of suture status (closed, normal, indeterminate) and interreader agreement.
Main Results:
- CUS demonstrated 100% sensitivity and 98% specificity for craniosynostosis diagnosis.
- High interreader agreement (100%) for sagittal, coronal, and lambdoid sutures.
- Discrepancies noted for the metopic suture, requiring potential further assessment.
Conclusions:
- CUS can be safely implemented as a primary imaging tool for investigating craniosynostosis in infants.
- CUS significantly reduces the necessity for radiographic imaging, minimizing radiation exposure.
- Further evaluation may be needed for precise metopic suture assessment using CUS.
Background:
Radiography, typically the first-line imaging study for diagnosis of craniosynostosis, exposes infants to ionizing radiation. We aimed to compare the accuracy of cranial ultrasound (CUS) with radiography for the diagnosis or exclusion of craniosynostosis.
Methods:
Children aged 0 to 12 months who were assessed for craniosynostosis during 2011-2013 by using 4-view skull radiography and CUS of the sagittal, coronal, lambdoid, and metopic sutures were included in this prospective study. Institutional review board approval and parental informed consent were obtained. CUS and radiography were interpreted independently and blindly by 2 pediatric radiologists; conflicts were resolved in consensus. Sutures were characterized as closed, normal, or indeterminate. Correlation between CUS and radiography and interreader agreement were examined for each suture.
Results:
A total of 126 children (82 boys, 64.5%) ages 8 to 343 days were included. All sutures were normal on CUS and radiography in 115 patients (93.7%); craniosynostosis of 1 suture was detected in 8 (6.3%, 5 sagittal, 2 metopic, 1 coronal). In 3 cases the metopic suture was closed (n = 2) or indeterminate on CUS (n = 1) but normally closed on radiography. CUS sensitivity was 100%, specificity 98% (95% confidence interval 94%-100%). Reader agreement was 100% for sagittal, coronal, and lambdoid sutures (κ = 0.80); after consensus, disagreement remained on 3 metopic sutures.
Conclusions:
In this series, CUS could be safely used as a first-line imaging tool in the investigation of craniosynostosis, reducing the need for radiographs in young children. Additional assessment may be required for accurate assessment of the metopic suture.
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