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Asymptomatic macrocephaly: to scan or not to scan.

Claire N Thomas1, Amy B Kolbe2, Larry A Binkovitz3

  • 1Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.

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|January 5, 2021
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Summary

Head ultrasound (US) is a useful screening tool for infants with macrocephaly. This study found US effectively identifies significant pathology, helping to exclude serious conditions when results are normal.

Keywords:
BrainHeadInfantMacrocephalyMacrocraniaUltrasound

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Area of Science:

  • Pediatric Neurology
  • Diagnostic Imaging
  • Neonatal Care

Background:

  • Macrocephaly is common in infants, often benign (idiopathic or familial).
  • Distinguishing concerning macrocephaly from normal variation requires careful evaluation.
  • Identifying underlying pathology is crucial for timely intervention.

Purpose of the Study:

  • To assess the utility of head ultrasound (US) screening in asymptomatic infants with macrocephaly.
  • To identify clinical factors associated with significant US findings in this population.

Main Methods:

  • Retrospective review of 440 infants with macrocephaly undergoing head US over 20 years.
  • Data included demographics, head circumference, physician specialty, US, CT/MRI findings, and clinical course.
  • Analysis focused on identifying associations between clinical factors and significant US findings.

Main Results:

  • 64% of US studies were normal; 31% had incidental findings.
  • Only 1.8% of infants had significant findings confirmed by CT/MRI (e.g., tumors, hydrocephalus).
  • Head circumference at birth was the only significant predictor of abnormal findings.

Conclusions:

  • Head ultrasound is a valuable initial diagnostic tool for infantile macrocephaly.
  • US can identify treatable causes and effectively rule out significant pathology when normal.
  • This imaging modality aids in clinical decision-making for asymptomatic infants.