Skip to main content
SpringerLink
Log in

Time course of sutural width during the physiological growth from birth to adulthood: CT quantitative and qualitative evaluations of sutural arches

  • Continuing Education
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

We performed a retrospective qualitative and quantitative evaluation of the sutural changes during the physiological growth to define the age-related ossification stages of major and minor skull sutures or synchondroses.

Methods

A total of 390 healthy subjects, examined for cranio-facial trauma and whose CT scans turned out to be normal, were clustered into homogenous age-matched groups ranged from birth to 90 years. High-resolution CT was used to assess the degree of sutural closure according to a 3-grade scoring system, the sutural pattern, the width, and the density of the gap calculated as the average of two or three ROIs along each suture/synchondrosis.

Results

The identification of a definite pattern depended on the suture’s type, the closure degree, and the width of the gap (p < 0.001). The interdigitation process was more intricate for most of vault sutures than the skull base sutures/synchondroses. Closing grades 1, 2, and 3 were associated to an identifiable sutural pattern and the cutoff value of 1.45 mm of the gap width allowed to detect an identifiable sutural pattern with the best combination of sensitivity (97%) and specificity (98%). Age and sutural closing degree were inversely related to gap width while positively related to the gap density (p < 0.001).

Conclusion

The sutural ossification is an age-related process, distinctive for each suture, and synchondrosis; it occurs neither according to a predefined order along sutural arches nor following a sequential distribution in the cranial fossae, and some sutures continued their growth process during lifetime.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

The data that support the findings of this study are available upon reasonable request.

References

  1. Miura T, Perlyn CA, Kinboshi M et al (2009) Mechanism of skull suture maintenance and interdigitation. J Anat 215:642–655. https://doi.org/10.1111/j.1469-7580.2009.01148.x

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wagemans PA, van de Velde JP, Kuijpers-Jagtman AM (1988) Sutures and forces: a review. Am J Orthod Dentofac Orthop 94:129–141. https://doi.org/10.1016/0889-5406(88)90361-7

    Article  CAS  Google Scholar 

  3. Wu Y-D, Chien C-H, Chao YJ et al (2007) Fourier analysis of human sagittal sutures. Cleft Palate-Craniofacial J Off Publ Am Cleft Palate-Craniofacial Assoc 44:482–493. https://doi.org/10.1597/06-122.1

    Article  Google Scholar 

  4. Ruengdit S, Troy Case D, Mahakkanukrauh P (2020) Cranial suture closure as an age indicator: A review. Forensic Sci Int 307:110111. https://doi.org/10.1016/j.forsciint.2019.110111

    Article  PubMed  Google Scholar 

  5. Skrzat J, Brzegowy P, Walocha J (2002) Computed tomographic assisted study of morphological changes in the sutural areas as resulting from obliteration. Folia Morphol 61:257–259

    Google Scholar 

  6. Jayaprakash PT, Srinivasan GJ (2013) Skull sutures: changing morphology during preadolescent growth and its implications in forensic identification. Forensic Sci Int 229:166.e1–13. https://doi.org/10.1016/j.forsciint.2013.03.038

    Article  PubMed  Google Scholar 

  7. Rice DP (2008) Developmental anatomy of craniofacial sutures. Front Oral Biol 12:1–21. https://doi.org/10.1159/000115028

    Article  PubMed  Google Scholar 

  8. Sim SY, Yoon SH, Kim SY (2012) Quantitative analysis of developmental process of cranial suture in korean infants. J Korean Neurosurg Soc 51:31–36. https://doi.org/10.3340/jkns.2012.51.1.31

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bailleul AM, Scannella JB, Horner JR, Evans DC (2016) Fusion patterns in the skulls of modern archosaurs reveal that sutures are ambiguous maturity indicators for the Dinosauria. PLoS One 11:e0147687. https://doi.org/10.1371/journal.pone.0147687

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Harth S, Obert M, Ramsthaler F et al (2009) Estimating age by assessing the ossification degree of cranial sutures with the aid of flat-panel-CT. Leg Med Tokyo Jpn 11(Suppl 1):S186-189. https://doi.org/10.1016/j.legalmed.2009.01.091

    Article  Google Scholar 

  11. Willershausen I, Erbe C, Al-Maawi S et al (2019) Development of a novel histological and histomorphometric evaluation protocol for a standardized description of the mid-palatal suture - an ex vivo study. J Anat 235:180–188. https://doi.org/10.1111/joa.12985

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Idriz S, Patel JH, AmeliRenani S et al (2015) CT of normal developmental and variant anatomy of the pediatric skull. Radiogr Rev Publ Radiol Soc N Am Inc 35:1585–1601. https://doi.org/10.1148/rg.2015140177

    Article  Google Scholar 

  13. Calandrelli R, Pilato F, Massimi L et al (2018) Quantitative evaluation of facial hypoplasia and airway obstruction in infants with syndromic craniosynostosis: relationship with skull base and splanchnocranium sutural pattern. Neuroradiology 60:517–528. https://doi.org/10.1007/s00234-018-2005-5

    Article  PubMed  Google Scholar 

  14. Calandrelli R, D’Apolito G, Massimi L et al (2016) Quantitative analysis of craniofacial dysmorphology in infants with anterior synostotic plagiocephaly. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 32:2339–2349. https://doi.org/10.1007/s00381-016-3218-8

    Article  Google Scholar 

  15. Madeline LA, Elster AD (1995) Suture closure in the human chondrocranium: CT assessment. Radiology 196:747–756. https://doi.org/10.1148/radiology.196.3.7644639

    Article  CAS  PubMed  Google Scholar 

  16. Manzanares MC, Goret-Nicaise M, Dhem A (1988) Metopic sutural closure in the human skull. J Anat 161:203–215

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Paetz P, Goetz GF, Lanfermann H, Giesemann AM (2017) The developing temporal bone: computed tomography measurements and assessment of suture closure from birth to 18 years of age. Surg Radiol Anat SRA 39:663–671. https://doi.org/10.1007/s00276-016-1786-7

    Article  CAS  PubMed  Google Scholar 

  18. Bertoglio B, Corradin S, Cappella A et al (2020) Pitfalls of computed tomography 3D reconstruction models in cranial nonmetric analysis. J Forensic Sci 65:2098–2107. https://doi.org/10.1111/1556-4029.14535

    Article  PubMed  Google Scholar 

  19. Massimi L, Bianchi F, Frassanito P et al (2019) Imaging in craniosynostosis: when and what? Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 35:2055–2069. https://doi.org/10.1007/s00381-019-04278-x

    Article  CAS  Google Scholar 

  20. Coll G, Sakka L, Botella C et al (2018) Pattern of closure of skull base synchondroses in Crouzon syndrome. World Neurosurg 109:e460–e467. https://doi.org/10.1016/j.wneu.2017.09.208

    Article  PubMed  Google Scholar 

  21. Mitchell LA, Kitley CA, Armitage TL et al (2011) Normal sagittal and coronal suture widths by using CT imaging. AJNR Am J Neuroradiol 32:1801–1805. https://doi.org/10.3174/ajnr.A2673

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Furuya Y, Edwards MS, Alpers CE et al (1984) Computerized tomography of cranial sutures. Part 1: comparison of suture anatomy in children and adults. J Neurosurg 61:53–58. https://doi.org/10.3171/jns.1984.61.1.0053

    Article  CAS  PubMed  Google Scholar 

  23. Coll G, Lemaire J-J, Di Rocco F et al (2016) Human foramen magnum area and posterior cranial fossa volume growth in relation to cranial base synchondrosis closure in the course of child development. Neurosurgery 79:722–735. https://doi.org/10.1227/NEU.0000000000001309

    Article  PubMed  Google Scholar 

  24. Anderson IA, Goomany A, Bonthron DT et al (2014) Does patient ethnicity affect site of craniosynostosis? J Neurosurg Pediatr 14:682–687. https://doi.org/10.3171/2014.9.PEDS14123

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168, Rome, Italy

    Rosalinda Calandrelli, Gabriella D’Apolito, Laura Tuzza & Cesare Colosimo

  2. Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy

    Fabio Pilato

  3. Operative Research Unit of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy

    Fabio Pilato

Authors
  1. Rosalinda Calandrelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabio Pilato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriella D’Apolito
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura Tuzza
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cesare Colosimo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Rosalinda Calandrelli: project development, data collection, manuscript writing.

Fabio Pilato: data collection, statistical analysis, manuscript writing.

Gabriella D’Apolito: data collection.

Laura Tuzza: data collection.

Cesare Colosimo: project development, manuscript writing.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fabio Pilato.

Ethics declarations

Conflict of interest

Rosalinda Calandrelli declares that she has no conflict of interest.

Fabio Pilato declares that he has no conflict of interest.

Gabriella D’Apolito declares that she has no conflict of interest.

Laura Tuzza declares that he she no conflict of interest.

Cesare Colosimo declares that he is scientific consultant for Bracco Diagnostics Inc. and Bayer HealthCare.

Ethical approval

We declare that all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Calandrelli, R., Pilato, F., D’Apolito, G. et al. Time course of sutural width during the physiological growth from birth to adulthood: CT quantitative and qualitative evaluations of sutural arches. Neuroradiology 65, 701–717 (2023). https://doi.org/10.1007/s00234-023-03129-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-023-03129-6

Keywords

Search

Navigation