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Updated: Oct 22, 2025
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Sutures ultrasound: useful diagnostic screening for posterior plagiocephaly
Silvia Marino1, Martino Ruggieri2, Lidia Marino3
1Unit of Pediatrics and Pediatric Emergency, AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy. silvia_marino86@hotmail.it.
Insights
Cranial suture ultrasound offers a highly sensitive and specific method for diagnosing infant skull deformities, distinguishing plagiocephaly from craniosynostosis. This non-invasive technique aids early detection, guiding further neurosurgical evaluation and intervention when necessary.
Area of Science:
- Pediatric Radiology
- Neurosurgery
- Diagnostic Imaging
Background:
- Posterior plagiocephaly (PP) is a common pediatric condition with two primary causes: postural plagiocephaly and craniosynostosis.
- Early diagnosis of PP is crucial to prevent potential neurological complications.
- Traditional diagnostic methods often involved late diagnosis and imaging with high radiation exposure.
Purpose of the Study:
- To evaluate the high sensitivity and specificity of suture ultrasound for the differential diagnosis of plagiocephaly and craniosynostosis.
- To establish suture ultrasound as an effective early diagnostic tool in pediatric patients.
Main Methods:
- A prospective study of infants with abnormal skull shapes was conducted, including clinical and ultrasound examinations.
- A systematic review of electronic medical databases (PubMed, Embase, Cochrane Library, Scopus, Web of Science) up to November 2020 was performed.
- Two eligible studies were identified and critically appraised for quality.
Main Results:
- Out of 120 infants examined, 105 (87.5%) presented with plagiocephaly and 15 (12.5%) with dolichocephaly/scaphocephaly.
- No associated malformations or neurological disorders were noted in the examined infants.
- One infant with a synostotic suture was accurately identified by ultrasonography and confirmed by 3D CT scan.
Conclusions:
- Cranial suture ultrasonography is an excellent, selective screening method for evaluating skull deformities in infants.
- It serves as a valuable first-line technique before proceeding to 3D CT scans and neurosurgical consultations.
- Pediatricians should consider incorporating cranial suture ultrasonography into routine clinical practice for early detection and management.
Purpose:
Posterior plagiocephaly (PP) is a common clinical condition in pediatric age. There are two main causes of PP: postural plagiocephaly and craniosynostosis. Early diagnosis is important, as it prevents neurological complications and emergencies. Diagnosis in the past was often made late and with imaging tests that subjected the infant to a high radiation load. Suture ultrasound does not use ionizing radiation; it is easy to perform, allows an early diagnosis, and directs toward the execution of the cranial 3D-CT scan, neurosurgical consultation, and possible intervention. The aim of the study is to describe the high sensitivity and specificity of suture ultrasound for the differential diagnosis between plagiocephaly and craniosynostosis.
Methods:
We reported our prospective experience and compared it with the data in the literature through a systematic review. The systematic review was conducted on electronic medical databases (PubMed, Embase, Cochrane Library, Scopus, and Web of Science) evaluating the published literature up to November 2020. According to Preferred Reporting Items for Systematic Reviews and Meta-ANALYSES (PRISMA statement), we identified 2 eligible studies. Additionally, according to AMSTAR 2, all included reviews have been critically rated as high quality. A total of 120 infants with abnormal skull shape were examined in NICU. All underwent clinical and ultrasound examination.
Results:
Of the total, 105 (87.5%) had plagiocephaly and 15 dolichocephaly/scaphocephaly (12.5%). None of these had associated other types of malformations and/or neurological disorders. The synostotic suture was identified ultrasonographically in 1 infant and subsequently confirmed by 3D CT scan (100%).
Conclusion:
Cranial sutures ultrasonography can be considered in infants a selective, excellent screening method for the evaluation of skull shape deformities as first technique before the 3D CT scan exam and subsequent neurosurgical evaluation. Cranial suture ultrasonography should be considered part of clinical practice especially for pediatricians.
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