Related Experiment Video
Updated: Mar 21, 2026
Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
Diagnostic Yield of Routine Skull Radiographs in Infants With Deformational Plagiocephaly
Insights
Routine skull radiographs for infant plagiocephaly have a low diagnostic yield. This study questions the benefit of routine imaging due to low detection rates of craniosynostosis and associated risks.
Area of Science:
- Pediatric Neurosurgery
- Radiology
- Craniofacial Surgery
Background:
- Differentiating synostotic (fused sutures) and nonsynostotic (flat head) plagiocephaly in infants is clinically challenging.
- Providers often order screening skull radiographs for infants with plagiocephaly.
- The diagnostic utility of these routine radiographs has not been previously established.
Purpose of the Study:
- To evaluate the diagnostic yield of routine screening skull radiographs in infants diagnosed with plagiocephaly.
- To determine the effectiveness of radiographs in differentiating synostotic from nonsynostotic plagiocephaly.
- To assess the rate of true craniosynostosis detected via screening radiographs.
Main Methods:
- Retrospective chart review of 1219 infants with plagiocephaly evaluated at a tertiary care center from 2010-2012.
- Analysis of clinical data, demographic information, and radiographic findings from skull radiographs and CT scans.
- Calculation of diagnostic yield for identifying craniosynostosis.
Main Results:
- Of 1213 infants who received screening radiographs, 24% had abnormal findings, and 7.6% showed signs suggestive of craniosynostosis.
- Only three infants (0.2%) were ultimately diagnosed with true craniosynostosis after follow-up.
- In contrast, 50% of infants who underwent CT without prior radiographs were diagnosed with true craniosynostosis.
Conclusions:
- Routine screening skull radiographs demonstrate a low diagnostic yield for identifying craniosynostosis in infants with plagiocephaly.
- The routine use of skull radiographs in this setting is questionable due to low diagnostic value, cost, and radiation exposure.
- Alternative diagnostic pathways may be more effective for evaluating infants with plagiocephaly.
Objective:
Differentiating synostotic and nonsynostotic plagiocephaly can be challenging, and many providers routinely obtain screening skull radiographs when evaluating an infant with plagiocephaly. However, the diagnostic yield of radiographs has not been studied in this clinical setting.
Design:
This study was a retrospective chart review.
Setting:
The study took place in a tertiary care center.
Patients:
We retrospectively reviewed the records of all patients referred to Children's Medical Center (Dallas, TX) between the years 2010 to 2012 with a diagnosis of plagiocephaly. After an initial evaluation, skull radiographs were obtained to rule out craniosynostosis. We reviewed clinical and demographic data and radiographic findings to determine the diagnostic yield of routine screening radiographs in infants presenting with plagiocephaly.
Results:
There were 1219 patients in total, and 1213 of these patients received screening four-view conventional skull radiographs. Six had computed tomography without prior radiographs. Of the patients in the skull radiograph group, 24% (289 of 1213) had abnormal radiographic findings, and 7.6% of this group (22 of 289) had findings that were indicative of craniosynostosis. Of these 22 patients, 12 obtained follow-up studies, and only three patients (0.2% of skull group) had true craniosynostosis. In comparison, 50% (three of six) in the group of patients who underwent computed tomography without prior conventional screening radiographs had true craniosynostosis.
Conclusions:
Routine screening skull radiographs have a low diagnostic yield in differentiating between synostotic and nonsynostotic plagiocephaly in patients presenting to a tertiary care deformational plagiocephaly clinic. Considering the costs and radiation exposure, the benefit of the routine use of skull radiographs in patients with deformational plagiocephaly is questionable.
Related Concept Videos
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...