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Craniofacial Soft-Tissue Anthropomorphic Database with Magnetic Resonance Imaging and Unbiased Diffeomorphic
Dillan F Villavisanis1, Pulkit Khandelwal2, Zachary D Zapatero1
1From the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia.
Insights
Developing a racially and ethnically sensitive 3D craniofacial database aids surgeons in assessing pediatric surgical outcomes. This database provides normal anatomical parameters for objective comparison and improved patient care.
Area of Science:
- Medical Imaging
- Pediatric Surgery
- Anthropometry
Background:
- Assessing pediatric craniofacial surgery outcomes is complex due to diverse patient presentations and growth.
- Current methods lack robust quantification of anatomical measurements and objective comparison of dysmorphology.
- A need exists for sensitive, objective tools to evaluate craniofacial anatomy and surgical results.
Purpose of the Study:
- To develop a racially and ethnically sensitive anthropomorphic database of craniofacial anatomy.
- To provide plastic and craniofacial surgeons with normative 3D anatomical parameters.
- To aid in the objective appraisal and optimization of aesthetic and reconstructive surgical outcomes.
Main Methods:
- Retrospective study of head MRI scans from 130 pediatric patients with normal craniofacial anatomy (2008-2021).
- Construction of composite (template) 3D images using diffeomorphic image registration (Advanced Normalization Tools).
- Generation of binary 3D segmentations for anatomical measurements using Materalise Mimics software.
Main Results:
- 12 composite templates were generated from 130 MRI scans, representing 3-, 4-, and 5-year-olds across diverse demographics.
- Average head circumferences for 3-, 4-, and 5-year-old composites were 50.3, 51.5, and 51.7 cm, aligning with WHO normative data.
- The method effectively created 3D templates of normal craniofacial and soft-tissue anatomy.
Conclusions:
- Diffeomorphic registration-based image templating is effective for creating 3D "normal" craniofacial anatomy models from MRI.
- Future work includes developing automated tools for anatomical normality characterization and grading.
- The goal is to reduce subjectivity in assessing preoperative severity and postoperative results.
Background:
Objective assessment of craniofacial surgery outcomes in a pediatric population is challenging because of the complexity of patient presentations, diversity of procedures performed, and rapid craniofacial growth. There is a paucity of robust methods to quantify anatomical measurements by age and objectively compare craniofacial dysmorphology and postoperative outcomes. Here, the authors present data in developing a racially and ethnically sensitive anthropomorphic database, providing plastic and craniofacial surgeons with "normal" three-dimensional anatomical parameters with which to appraise and optimize aesthetic and reconstructive outcomes.
Methods:
Patients with normal craniofacial anatomy undergoing head magnetic resonance imaging (MRI) scans from 2008 to 2021 were included in this retrospective study. Images were used to construct composite (template) images with diffeomorphic image registration method using the Advanced Normalization Tools package. Composites were thresholded to generate binary three-dimensional segmentations used for anatomical measurements in Materalise Mimics.
Results:
High-resolution MRI scans from 130 patients generated 12 composites from an average of 10 MRI sequences each: four 3-year-olds, four 4-year-olds, and four 5-year-olds (two male, two female, two Black, and two White). The average head circumference of 3-, 4-, and 5-year-old composites was 50.3, 51.5, and 51.7 cm, respectively, comparable to normative data published by the World Health Organization.
Conclusions:
Application of diffeomorphic registration-based image template algorithm to MRI is effective in creating composite templates to represent "normal" three-dimensional craniofacial and soft-tissue anatomy. Future research will focus on development of automated computational tools to characterize anatomical normality, generation of indices to grade preoperative severity, and quantification of postoperative results to reduce subjectivity bias.
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