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Related Experiment Videos

Plagiocephaly: differential diagnosis based on endocranial morphology

L J Lo1, J L Marsh, T K Pilgram

  • 1Division of Plastic and Reconstructive Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo., USA.

Plastic and Reconstructive Surgery
|February 1, 1996
PubMed
Summary

Plagiocephaly diagnosis is clarified using 3D CT scans. Quantitative analysis of endocranial base morphology accurately differentiates unicoronal synostosis, unilambdoid synostosis, and plagiocephaly without synostosis.

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Area of Science:

  • Craniofacial surgery
  • Radiology
  • Pediatric neurosurgery

Background:

  • Plagiocephaly, a common cranial asymmetry, has multiple causes including unicoronal synostosis, unilambdoid synostosis, and non-synostotic plagiocephaly.
  • Distinguishing these etiologies can be challenging, even for experienced clinicians using conventional imaging.
  • High-resolution CT scans with 3D reconstructions are increasingly used for craniofacial anomaly evaluation.

Purpose of the Study:

  • To determine if endocranial 3D CT osseous surface reformations can unambiguously differentiate the three main etiologies of plagiocephaly.
  • To define and quantify endocranial base morphologies specific to each plagiocephaly etiology.

Main Methods:

  • Review of archival pretreatment CT data from 15 unicoronal synostosis, 4 unilambdoid synostosis, and 15 non-synostotic plagiocephaly patients.

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  • Qualitative and quantitative analysis of endocranial base morphologies.
  • Blind evaluation of 3D CT images by four experienced radiologists to differentiate the etiologies.

    • Main Results:

    • Endocranial base morphology is etiology-specific for the three main types of plagiocephaly.
    • Radiologists accurately diagnosed unicoronal synostosis but had difficulty differentiating unilambdoid synostosis and non-synostotic plagiocephaly based on visual inspection alone.
    • Quantification of anterior and posterior cranial fossae midline angulation significantly improved differentiation accuracy in challenging cases.

    Conclusions:

    • 3D CT endocranial base imaging provides etiology-specific dysmorphology patterns for plagiocephaly.
    • Quantitative analysis of endocranial base morphology, particularly midline angulation, is crucial for accurate differential diagnosis of plagiocephaly etiologies.