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Updated: Oct 15, 2025
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Challenging the Norm: Is Routine Use of Cranial CT in Evaluation of Craniosynostosis Necessary?
Artur Fahradyan1, Giulia Daneshgaran2, Trevor L Hoffman3
1Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA.
Insights
For infants with nonsyndromic single-suture craniosynostosis, experienced clinicians accurately diagnosed most cases without cranial CT (computed tomography). Preoperative imaging is often unnecessary, challenging current diagnostic standards.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Medical Imaging
Background:
- Cranial CT (computed tomography) is considered the gold standard for diagnosing craniosynostosis.
- The risks of infant CT scans necessitate evaluating their diagnostic necessity.
- This study questions the routine use of CT for suspected nonsyndromic single-suture craniosynostosis.
Purpose of the Study:
- To assess if cranial CT offers enhanced diagnostic accuracy compared to physical examination for craniosynostosis.
- To evaluate the necessity of preoperative imaging in infants with suspected nonsyndromic single-suture craniosynostosis.
Main Methods:
- Retrospective chart review of 138 patients with nonsyndromic single-suture craniosynostosis.
- Analysis of clinical diagnosis, imaging findings, and intraoperative confirmation.
- Comparison of diagnoses made with and without preoperative imaging.
Main Results:
- Experienced clinicians achieved a clinical diagnosis in 92% of infants without prior imaging.
- Only 7% of cases required radiography for diagnosis when initial clinical assessment was unclear.
- Preoperative cranial CT was not essential for diagnosis in 93% of patients.
Conclusions:
- Cranial CT is frequently unnecessary for diagnosing nonsyndromic single-suture craniosynostosis by experienced craniofacial providers.
- Preoperative imaging before specialist consultation may be redundant.
- Findings challenge the established role of cranial CT as the gold standard in these cases.
Background:
Cranial CT is routinely taught to be the gold standard for diagnosis of craniosynostosis and used by craniofacial teams for suspected nonsyndromic single suture craniosynostosis. Given the risks associated with infant CTs, do these scans provide significantly enhanced diagnostic accuracy compared to the physical exam when performed by an experienced clinical provider?
Method:
A retrospective chart review was performed for children who underwent corrective surgery for nonsyndromic, single-suture craniosynostosis over an 11 year period by a single craniofacial team. Ages at presentation and surgery, preoperative clinical diagnosis and imaging, co-existing radiographic findings, and correlation with the intraoperative diagnosis were analyzed.
Results:
A total of 138 patients were included in this study. The mean age was 4.2 months at initial craniofacial evaluation, and 8.0 months at time of surgery. Twenty-seven patients received imaging prior to our clinic. Of those, 21 had plain radiography and 6 had CT scans. Of the remaining 111 patients referred without imaging, craniosynostosis was clinically diagnosed in 102 (92%), whereas 9 (8%) had an unclear clinical diagnosis. Of these 9, 1 (1%) was diagnosed clinically at follow-up exam, and the remaining 8 (7%) were diagnosed using radiography (3 CT scans, 5 plain radiographs). In all patients, the preoperative diagnosis was confirmed during intraoperative assessment.
Conclusions:
Cranial CT was not needed by experienced craniofacial providers in 93% of nonsyndromic, single-suture craniosynostosis. Imaging obtained before craniofacial clinic referral may have been unnecessary. These findings question the classic teaching that preoperative cranial CT is the gold standard for diagnosis in infants with nonsyndromic, single-suture craniosynostosis.
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