Surface Cranial Ultrasound: The Natural Heir to X-Ray for the Screening of Skull Deformities in Infants

Abstract

Purpose Volumetric tomography (3D-CT) is currently considered the gold standard for the diagnosis of craniosynostosis, but its use as the first-line examination for cranial deformities is a topic of debate, because of skull X-ray radiation and low sensitivity and specificity. Cranial ultrasound is an emerging noninvasive radiation-free alternative, but its diagnostic accuracy still needs confirmation.

Materials and Methods The present prospective study included 350 infants with skull deformities, who underwent cranial ultrasound as the first-line examination, followed by 3D-CT if the echography results was positive or unclear. If the results were negative, infants underwent physical treatment and follow-up. To evaluate ultrasound reliability, we focused on cases that underwent both the index test and the gold standard and performed a double-blind comparison of the echography and 3D-CT results.

Results Ultrasound documented patent sutures in 293 infants and 9 had inconclusive results. The 293 ultrasound-negative infants were followed clinically: all improved, except 28 that underwent 3D-CT. In all of these cases, 3D-CT confirmed the ultrasonography results (no false negatives). 48 infants showed premature suture closure and underwent 3D-CT: 47 were confirmed (true positive), 1 was false positive. The sensitivity was 100%, the specificity was 99.7%, the positive and negative predictive values were 97.9% and 100%, respectively, the accuracy was 99.7%, and the diagnostic test evaluation was conclusive.

Conclusion The study documented the high sensitivity and specificity of echography for the diagnosis of craniosynostosis in a referral center, with better results being achieved before 6 months of age. Major limitations are the loss of diagnostic significance as the child grows and the learning curve needed. The advantages are avoidance of radiation and chance to evaluate the brain at the same time.

Zusammenfassung

Ziel Die volumetrische Tomografie (3D-CT) gilt derzeit als Goldstandard für die Diagnose von Kraniosynostosen, ist jedoch für die Erstuntersuchung von Schädeldeformitäten aufgrund der Strahlenbelastung und der geringen Sensitivität/Spezifität umstritten. Die kraniale Sonografie ist eine aufkommende, nicht-invasive, strahlungsfreie Alternative, aber ihre diagnostische Genauigkeit muss noch bestätigt werden.

Material und Methoden Die vorliegende prospektive Studie umfasste 350 Säuglinge mit Schädeldeformitäten, die als Erstuntersuchung einem kranialen Ultraschall unterzogen wurden, gefolgt von einer 3D-CT, wenn die sonografischen Befunde positiv oder fraglich waren. War der Befund negativ, wurden die Kinder ärztlich behandelt und nachuntersucht. Um die Zuverlässigkeit der Sonografie zu bewerten, konzentrierten wir uns auf Fälle, die sowohl dem Index-Test als auch dem Goldstandard unterzogen wurden, und verglichen unter doppelter Verblindung Sonografie- und 3D-CT-Befunde.

Ergebnisse Bei 293 Säuglingen wurden sonografisch offene Nähte nachgewiesen, bei 9 Kindern war der Befund nicht eindeutig. Die 293 Säuglinge mit unauffälligem sonografischen Befund wurden klinisch nachverfolgt: Bei allen, verbesserte sich das klinische Bild, mit Ausnahme von 28, die mit 3D-CT untersucht wurden. In all diesen Fällen bestätigte die 3D-CT den Ultraschallbefund (keine falsch-negativen). 48 Säuglinge zeigten einen verfrühten Nahtverschluss und wurden einer 3D-CT unterzogen: 47 Fälle wurden bestätigt (richtig-positive), 1 Fall war falsch-positiv. Die Sensitivität betrug 100 %, die Spezifität 99,7 %, der positive und negative Vorhersagewert 97,9 % bzw. 100 %, die Genauigkeit 99,7 %. Die Evaluation des diagnostischen Tests war schlüssig.

Schlussfolgerung Die Studie dokumentiert die hohe Sensitivität und Spezifität der Sonografie bei der Diagnose der Kraniosynostose in einem Spezialzentrum, mit besseren Ergebnissen vor dem 6. Lebensmonat. Die wichtigsten Einschränkungen sind die geringere Aussagekraft bei zunehmendem Alter und der erforderliche Lernprozess; Vorteile sind die Vermeidung der Strahlenbelastung und die Möglichkeit, das Gehirn gleichzeitig zu untersuchen.

Keywords

cranial ultrasound - craniosynostosis - infants - computerized tomography - cranial sutures

Publication History

Received: 22 September 2020

Accepted after revision: 13 March 2022

Article published online:
27 June 2022

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