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Child's Nervous System

, Volume 33, Issue 9, pp 1545–1552 | Cite as

Cranial ultrasound is a reliable first step imaging in children with suspected craniosynostosis

  • L. PoglianiEmail author
  • G. V. Zuccotti
  • M. Furlanetto
  • V. Giudici
  • A. Erbetta
  • L. Chiapparini
  • L. Valentini
Original Paper

Abstract

Purpose

Skull radiography (SR) and Computed Tomography (CT) are still proposed as the first-line imaging choice for the diagnosis of craniosynostosis (CS) in children with abnormal head shape, but both techniques expose infants to ionizing radiation. Several studies shown that ultrasound may play an important role in the diagnosis of craniosynostosis. The aim of our study is to assess the diagnostic accuracy of cranial ultrasound scan (CUS) and confirm if it is a reliable first step imaging evaluation for the diagnosis of craniosynostosis in newborn.

Method

A cohort of 196 infants (122/74 males/females), with a mean age of 4 months, clinically suspected to have abnormal closure of cranial sutures, were firstly examined by CUS and then referred to neuroradiologists to perform volumetric CT scan if the suspicion of stenosis was ecographically confirmed; otherwise, a routine follow-up and physical treatment was performed, to observe the evolution of the head shape.

Results

Of the 196 children studied by CUS, only two had inconclusive studies due to age limitation (>12 months). Thirty children were diagnosed with cranial synostosis at CUS and verified by CT; all the CUS results were confirmed, except two cases, that were revealed as false positives in the starting phase of the study. Twelve patients with very prominent head deformity and negative CUS underwent CT, which confirmed the CUS results in all of them; one case of closure of both temporal sutures, not studied by CUS, was documented by CT. All the 148 children with poor clinical suspicion and negative CUS underwent just a prolonged clinical follow-up. In all of them, a progressive normalization of head shape was observed, and the craniosynostosis was excluded on a clinical base.

Conclusions

CUS is a highly specific and sensitive imaging technique. In referral centers, expert hands can use it as a reliable first-step screening for infants younger than 1 year, suspected to have a craniosynostosis, thus avoiding unnecessary exposure to ionizing radiation. The “golden age” to obtain the best CUS results is under 6 months of life. Because the method is operator-dependent and there is a learning curve, a case centralization is advisable.

Keywords

Craniosynostosis Cranial ultrasound Suture Computerized tomography 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Agrawal D, Steinbok D, Douglas P (2006) Diagnosis of isolated sagittal synostosis: are radiographic studies necessary? Childs Nerv Syst 22:375–378CrossRefPubMedGoogle Scholar
  2. 2.
    Alden TD, Lin KY, Jane JA (1999) Mechanisms of premature closure of cranial sutures. Childs Nerv Syst 15:670–675CrossRefPubMedGoogle Scholar
  3. 3.
    Alizadeh H (2013) Diagnostic Accuracy of Ultrasonic Examination in Suspected Craniosynostosis Among Infants. Indian Pediatrics 50:148–150CrossRefPubMedGoogle Scholar
  4. 4.
    Blank CE (1960) Apert’s syndrome (a type of acrocephalosyndacytly)- observation on a British series of thirty-nine cases. Ann Hum Genet 24:151–164CrossRefPubMedGoogle Scholar
  5. 5.
    Bonfield CM, Cochrane DD, Singhal A, Steinbok P (2015) Preoperative ultrasound localization of the lambda in patients with scaphocephaly: a technical note for minimally invasive craniectomy. J Neurosurg Pediatr 28:1–3Google Scholar
  6. 6.
    Helen BM, Manoar S (2011) Craniosynostosis and 3-dimensional computed tomography. Seminars in Ultrasound CT and MRI 32(6):569–577CrossRefGoogle Scholar
  7. 7.
    Brenner D, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296CrossRefPubMedGoogle Scholar
  8. 8.
    Brenner D, Hall E (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284CrossRefPubMedGoogle Scholar
  9. 9.
    Cohen MM Jr (1991) Etiopathogenesis of craniosynostosis. Neurosurg Clin N Am 2(3):507–513PubMedGoogle Scholar
  10. 10.
    Cohen MM Jr (2000) Craniosynostosis: diagnosis, evaluation and management. 2nd ed. New York Oxford University Press 3–50Google Scholar
  11. 11.
    Cunningham ML, Seto ML, Ratisoontorn C, Heike CL, Hing AV (2007) Syndromic craniosynostosis: from history to hydrogen bonds. Orthod Craniofac Res 10(2):67–81CrossRefPubMedGoogle Scholar
  12. 12.
    Domeshek LF, Mukundan S Jr, Yoshizumi T, Marcus JR (2009) Increasing concern regarding computed tomography irradiation in craniofacial surgery. Plast Reconstr Surg 123:1313–1320CrossRefPubMedGoogle Scholar
  13. 13.
    Ernst CW, Hulstaert TL, Belsack D, Buls N, Van Gompel G, Nieboer KH, Buyl R, Verhelle F, De Maeseneer M, de Mey J (2016) Dedicated sub 0.1 mSv 3DCT using MBIR in children with suspected craniosynostosis: quality assessment. Eur Radiol 26:892–899CrossRefPubMedGoogle Scholar
  14. 14.
    Fearon J, Singh D, Beals S, Yu J (2007) The diagnosis and treatment of single-sutural synostoses: are computed tomographic scans necessary? Plast Reconstr Surg 120:1327–1331CrossRefPubMedGoogle Scholar
  15. 15.
    Haaga J (2001) Radiation dose management: weighing risk from benefit. Am J Roentgenol 177:289–291CrossRefGoogle Scholar
  16. 16.
    Hall E (2002) Lesson we have learned from our children: cancer risks from diagnostic radiology. PediatrRadiol 32:700–706Google Scholar
  17. 17.
    Hertz JM, Juncker I, Christensen L, Ostergaard JR, Jensen PK (2001) The molecular genetic background of hereditary craniosynostosis and chondrodysplasias. Ugeskr Laeger 163(36):4862–4867PubMedGoogle Scholar
  18. 18.
    Huelke DF, (1998) An overview of anatomical considerations of infants and children in the adult world of automobile safety designs. Annu Proc Assoc Adv Automot Med 42:93-4Google Scholar
  19. 19.
    Kaasalainen T, Palmu K, Lampinen A, Reijonen V, Leikola J, Kivisaari R, Kortesniemi M (2015) Limiting CT radiation dose in children with craniosynostosis: phantom study using model-based iterative reconstruction. Pediatr Radiol 45:1544–1553CrossRefPubMedGoogle Scholar
  20. 20.
    Kotrikova B, Krempien R, Freier K, Mühling J (2007) Diagnostic imaging in the management of craniosynostoses. Eur Radiol 17:1968–1978CrossRefPubMedGoogle Scholar
  21. 21.
    Krimmel M, Will B, Wolff M, Kluba S, Haas-Lude K, Schaefer J, Schuhmann MU, Reinert S (2012) Value of high-resolution ultrasound in the differential diagnosis of scaphocephaly and occipital plagiocephaly. Int J Oral Maxillofac Surg 41(7):797–800CrossRefPubMedGoogle Scholar
  22. 22.
    Linz C, Collmann H, Meyer-Marcotty P, Bohm H, Krauss J, Muller-Richter UD, Ernestus RI, Wirbelauer J, Kubler AC, Schweitzer T (2015) Occipital plagiocephaly: unilateral lambdoid synostosis versus positional plagiocephaly. Arch Dis Child:152–157Google Scholar
  23. 23.
    Muller U, Steinberger D, Kunze S (1997) Molecular genetics of craniosynostotic syndrome. Graefes Arch Clin Exp Ophthalmol 235(9):545–550CrossRefPubMedGoogle Scholar
  24. 24.
    Nguyen C, Hernandez-Boussard T, Khosla RK, Curtin CM (2013) A national study on craniosynostosis. Cleft Palate Craniofac J 50(5):555–560CrossRefPubMedGoogle Scholar
  25. 25.
    Nur BG, Pehlivanoglu S, Mihci E et al (2014) Clinicogenetic study of Turkish patients with syndromic craniosynostosis and literature review. Pediatr Neurol 50(5):482–490CrossRefPubMedGoogle Scholar
  26. 26.
    Pearce MS, Salotti JA, Little MP, McHugh K et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Persing J, James H, Swanson J, Kattwinkel J (2003) Committee on practice and ambulatory medicine, section on plastic surgery, et al: prevention and management of positional skull deformities in infants. Pediatrics 112:199–202CrossRefPubMedGoogle Scholar
  28. 28.
    Regelsberger J, Gunter D, Michael T, Knuth H, Gertrude K, Heidi K, Manfred W (2006) High-frequency ultrasound confirmation of positional plagiocephaly. J Neurosurg 105(5 Suppl Pediatrics):413–417PubMedGoogle Scholar
  29. 29.
    Regelsberger J, Gunter D, Michael T, Knuth H, Gertrude K, Heidi K, Manfred W (2006) Ultrasound in the diagnosis of craniosynostosis. J Craniofac Surg 17:623–625 discussion 626–628CrossRefPubMedGoogle Scholar
  30. 30.
    Robinson S, Proctor M (2009) Diagnosis and management of deformational plagiocephaly. J Neurosurg Pediatr 3:284–295CrossRefPubMedGoogle Scholar
  31. 31.
    Rozovsky K, Udjus K, Wilson N, Barrowman NJ, Simanovsky N, Miller E (2016) Cranial ultrasound as a first-line imaging examination for craniosynostosis. Pediatrics 137(2):e20152230CrossRefPubMedGoogle Scholar
  32. 32.
    Böhm SH, Meyer-Marcotty P, Collmann H, Ernestus R-I, Krauß J (2012) Avoiding CT scans in children with single-suture craniosynostosis. Childs Nerv Syst 28:1077–1082CrossRefPubMedGoogle Scholar
  33. 33.
    Sim SY, Yoon SH, Kim SY (2012) Quantitative analyses of developmental process of cranial suture in Korean infants. J Korean Neurosurg Soc 51:31–36CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Simanovsky N, Hiller N, Koplewitz B, Rozovsky K (2009) Effectiveness of ultrasonographic evaluation of the cranial sutures in children with suspected craniosynostosis. Eur Radiol 19:687–692CrossRefPubMedGoogle Scholar
  35. 35.
    Soboleski D, McCloskey D, Mussari B, Sauerbrei E, Clarke M, Fletcher A (1997) Sonography of normal cranial sutures. Am J Roentgenol 168:819–821CrossRefGoogle Scholar
  36. 36.
    Soboleski D, Mussari B, McCloskey D, Sauerbrei E, Espinosa F, Fletcher A (1998) High-resolution sonography of the abnormal cranial suture. Pediatr Radiol 28:79–82CrossRefPubMedGoogle Scholar
  37. 37.
    Speltz LM, Kapp-Simon KA, Cunningham M, Marsh J, Dawson G, Single (2004) Suture craniosynostosis: a review of neurobehavioral research and theory. Journal of Pediatric Psychology 29(8):651–668CrossRefPubMedGoogle Scholar
  38. 38.
    Starr JR, Kapp-Simon KA, Cloonan YK, Collett BR, Cradock MM, Buono L, Cunningham ML, Speltz LM (2007) Presurgical and postsurgical assessment of the neurodevelopment of infants with single-suture craniosynostosis: comparison with controls. J Neurosurg 107(2 Suppl Pediatrics):103–110PubMedPubMedCentralGoogle Scholar
  39. 39.
    Sze R, Parisi M, Sidhu M, Paladin A, Ngo A, Seidel K, Weinberger E, Ellenbogen R, Grus Cunningham M (2003) Ultrasound screening of the lambdoid suture in the child with posterior plagiocephaly. Pediatr Radiol 33:630–636CrossRefPubMedGoogle Scholar
  40. 40.
    Tureci E, Asan Z, Eser M, Tanriverdi T, Alkan F, Erdincler PJ (2011) The effects of valproic acid and levetiracetam on chicken embryos. Clin Neurosci 18(6):816–820CrossRefGoogle Scholar
  41. 41.
    Vu HL, Panchal J, Parker EE, Levine NS, Francel P (2001) The timing of fisiologic closure of the metopic suture: a review of 159 patients using reconstructed 3D CT scans of the craniofacial region. J Craniofac Surg 12(6):527–532CrossRefPubMedGoogle Scholar
  42. 42.
    George Z, Montes DM, Woerner JE, Christina Notarianni GE, Ghali (2014) Surgical correction of craniosynostosis. A review of 100 cases. Journal of Cranio-Maxillo-Facial Surgery 42(8):1684–1691CrossRefGoogle Scholar
  43. 43.
    Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Diagnosis of Patients with Positional Plagiocephaly: the Role of Imaging. Neurosurgery. (2016) Nov;79(5):E625-E626.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • L. Pogliani
    • 1
    Email author
  • G. V. Zuccotti
    • 2
  • M. Furlanetto
    • 3
  • V. Giudici
    • 2
  • A. Erbetta
    • 4
  • L. Chiapparini
    • 4
  • L. Valentini
    • 3
  1. 1.Department of PaediatricsUniversity of Milan, Luigi Sacco HospitalMilanItaly
  2. 2.Department of PediatricsUniversity of Milan, Milan Children’s Hospital V. BuzziMilanItaly
  3. 3.Department of Neurosurgery C. Besta” Neurological InstituteMilanItaly
  4. 4.Service of Neuroradiology: “C. Besta” Neurological InstituteMilanItaly

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