Practical Computed Tomography Scan Findings for Distinguishing Metopic Craniosynostosis from Metopic Ridging

Area of Science:

• Craniofacial Surgery
• Pediatric Neurosurgery
• Radiology

Background:

• Metopic craniosynostosis (MCS) involves premature fusion of the metopic suture, often confused with physiological metopic ridging (MR).
• While MR is managed non-surgically, MCS requires surgical intervention, highlighting the importance of accurate diagnosis.
• Computed tomography (CT) scans provide valuable diagnostic information in challenging cases.

Purpose of the Study:

• To identify specific CT scan findings that differentiate metopic craniosynostosis (MCS) from metopic ridging (MR).
• To improve diagnostic accuracy for metopic suture abnormalities.

Main Methods:

• Analysis of de-identified CT scans from patients with MCS (n=52), MR (n=20), and controls (n=52).
• Blinded assessment by four expert clinicians evaluating features of orbits, frontal bones, and inner table of calvaria.
• Inclusion of interfrontal divergence angle in the analysis.

Main Results:

• No single CT feature was diagnostic for MCS.
• Posteriorly displaced frontal bone and frontal bone tangent to mid-orbit or medial were correlated with MCS.
• Combined CT features and interfrontal divergence angle improved diagnostic accuracy.

Conclusions:

• A closed metopic suture combined with specific CT findings enhances the accuracy of diagnosing MCS and MR.
• CT imaging is a valuable tool for differentiating metopic craniosynostosis from metopic ridging.
• Accurate diagnosis impacts treatment decisions, distinguishing surgical from non-surgical management.