Necessity of Intracranial Imaging in Infants and Children With Macrocephaly

Area of Science:

• Pediatric Neurology
• Medical Imaging
• Clinical Risk Assessment

Background:

• Macrocephaly is a common pediatric condition frequently prompting neuroimaging.
• Current imaging guidelines for macrocephaly are lacking from major pediatric and radiology organizations.
• This study aims to identify risk factors for pathologic macrocephaly to guide clinical imaging decisions.

Purpose of the Study:

• To identify clinical risk factors associated with pathologic macrocephaly.
• To assist clinicians in determining which pediatric patients with macrocephaly would benefit from neuroimaging.
• To reduce unnecessary imaging in pediatric patients with macrocephaly.

Main Methods:

• A retrospective medical record review was conducted across a multistate healthcare system from 2012-2016.
• Patients under 36 months with macrocephaly were identified, and data on demographics, imaging, and clinical outcomes were collected.
• Key data points included developmental delay, neurological symptoms, and family history of macrocephaly.

Main Results:

• Out of 169 patients, 13 had abnormal imaging studies, with five yielding high clinical significance.
• Abnormal imaging results were significantly associated with developmental delay (P=0.04) and neurological symptoms (P=0.015).
• A positive family history of macrocephaly was predictive of normal imaging findings (P=0.004), and no sedation complications occurred.

Conclusions:

• Intracranial imaging may not be necessary for children with macrocephaly who lack specific risk factors or have a positive family history.
• Developmental delay and neurological symptoms are key risk factors indicating potential imaging abnormalities requiring further management.
• This research aids in refining the diagnostic approach to pediatric macrocephaly, optimizing the use of neuroimaging.