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Estudio de la craneosinostosis por tomografía computarizada
Abstract
Objectives
To highlight the usefulness of Multi-Detector Computed Tomography (MD-CT) in the study of craniosynostosis.Material and methodsA total of 19 patients were studied from September 2007 to January 2011, using multi-detector computed tomography (VCT, General Electric Healthcare, Milwaukee, WI, USA). The images were reconstructed with a General Electric Healthcare Advantage Workstation 4.3.ResultsOf the 19 patients studied there were 9 scaphocephalies, 4 anterior plagiocephalies, 4 trigonocephalies, and 2 posterior plagiocephalies. Sedation was not required in any of them.Conclusions
Multi-detector computed tomography enables sutures to be assessed rapidly and efficiently, obtaining dose indices in accordance with the optimal diagnostic results when planning the most appropriate treatment.
... Sus principales indicaciones son ante casos en los que la clínica no es concluyente, así como para valoración prequirúrgica y postoperatoria. Nuevas técnicas de reconstrucción que utilizan bajas dosis de irradiación, han logrado disminuir la exposición a la misma, sin comprometer la calidad de imagen (1,2,10,23,26,(31)(32)(33)(34) . ...
... Está indicada cuando se evidencian alteraciones neurológicas o del desarrollo que sugieren una posible afectación del sistema nervioso central asociada. Recientemente se introdujo la secuencia "BlackBox", que minimiza el contraste de los tejidos blandos para mejorar la imagen de los bordes óseos, planteándose como posible sustituto de la tomografía, así también como una base para modelos impresos en 3D (8,31,(38)(39)(40) . ...
... Thyroid disorders are the most common of all endocrine diseases. If the CHT is not treated, it may cause severe mental retardation and stunted growth 11,12 . ...
Hypothyroidism is the most common thyroid disorder. It may be congenital if the thyroid gland does not develop properly. A female predominance is characteristic. Hypothyroidism is the most common congenital pediatric disease and its first signs and early symptoms can be detected with neonatal screening. Some of the oral manifestations of hypothyroidism are known to be: glossitis, micrognathia, macroglossia, macroquelia, anterior open bite, enamel hypoplasia, delayed tooth eruption, and crowding. This paper briefly describes the systemic and oral characteristics of congenital hypothyroidism in a patient being treated at a dental practice. The patient had early childhood caries and delayed tooth eruption. There are no cases of craniosynostosis related to the primary pathology, which if left untreated, increases the cranial defect. Early diagnosis reduces the clinical manifestations of the disease. Delayed tooth eruption will become a growing problem if the patient does not receive timely treatment and monitoring.
Primeras evidencias de deformación craneal intencional durante las fases II y III de la cultura Valdivia (c. 3,300-2,400 a.C.) en el sitio Real Alto Proyecto Integrador Previo a la obtención del Título de: Licenciado en Arqueología Presentado por:
Craniosynostosis is a common condition in the pediatric age group, which may either be isolated or may present as part of a craniofacial syndrome. This pictorial review illustrates the underlying mechanisms and pathophysiology of craniosynostosis, the various types of craniosynostoses, common craniofacial syndromes and the role of imaging in their diagnosis and management.
Dynamic Orthotic Cranioplasty (DOC) was developed to treat craniofacial deformities associated with positional plagiocephaly. This investigation describes the treatment of more than 750 patients with the DOC Band since 1988. All patients undergoing DOC treatment were fit with a custom fabricated orthosis made from a plaster impression taken from the infant's head. When the orthosis was applied, the corrective pressure was directed to hold growth at the calvarial prominences and redirect symmetrical growth. A detailed medical history was obtained and anthropometric measurements were taken at start, exit, 12, 18, and 24 months follow-up. This information was recorded in a database created in Microsoft Excel. Mean length of treatment was 4.3 months with an average entrance age of 6.9 months. Analysis of anthropometric data showed significant reduction in mean cranial vault, skull base, and facial asymmetries. Correction of the more difficult skull base was documented with computed tomography. Our anthropometric and clinical observations document complete or near complete correction of asymmetry for a wide variety of head shapes. Based on the results of this investigation, we are able to support the earlier claims of our pilot study, which concluded that DOC is effective in the treatment of positional plagiocephaly.
Three-dimensional computed tomography (CT) has an important role in determining the presence and extent of congenital and acquired craniofacial deformities. The authors compared the sensitivity and specificity of three-dimensional CT in the detection and characterization of craniosynostosis with that of planar CT and skull radiography. Eighty-two patients with isolated and syndromal synostoses were imaged with CT and three-dimensional CT, and 42 with skull radiography. Three-dimensional CT scan processing was performed by shaded-surface reconstruction, volumetric, and depth-coded methods. Two trained observers read each scan series in a blinded fashion. Diagnostic utility of the images was determined with receiver operating characteristic analysis. The observers ranked three-dimensional shaded images higher than the other types, with three-dimensional volumetric images second and three-dimensional surface images ranked third. Results of this study demonstrate that three-dimensional shaded-surface reconstruction from CT scans is superior to conventional plain radiographs and CT scans in diagnosing craniosynostosis.
Primary craniosynostosis, the premature closure of one or more cranial sutures, occurs in up to one in 2,500 births. Secondary causes of craniosynostosis include disorders that lead to failure of brain development and conditions that influence bone metabolism. The craniosynostoses result in skull deformities and increased intracranial pressure as the developing brain is compressed. Clinical signs and symptoms depend on which suture or combination of sutures are involved. The etiology of craniosynostosis is believed to concern genetic abnormalities in fibroblast growth factors or their receptors, and the craniosynostoses can be associated with other congenital syndromes. The most important differential diagnoses are molding that occurs during birth in young infants, and positional molding that occurs as a result of excessive time spent in the supine position in older infants. The diagnosis may be confirmed by plain films of the skull, and surgical treatment is usually indicated to prevent neurologic complications.
Conventional Computed Tomography (CT) with three-dimensional (3D) reconstructions is considered the most complete and accurate imaging modality to diagnose craniosynostosis. However, the introduction of Spiral CT (SCT) opened new possibilities for 3D studies of the skull in pediatric patients with craniosynostosis. The purpose of our study is two fold: first, to optimize the scanning and imaging parameters to obtain diagnostic images in a single spiral scan; second, to assess the diagnostic accuracy of such images in the identification of normal and abnormal cranial vault sutures.
Seventy-eight pediatric patients (age range: 1-35 months; mean: 11.8 months) with craniosynostosis were submitted to SCT of the head. The images were acquired with the following parameters: 3- and 5-mm nominal slice thickness, 5-6 mm/s table feed (pitch 1-2), 165 mAs and 120 kV. Two different algorithms and increases were used for image reconstructions. A first set of images was reconstructed with 2-mm increases and a soft tissue algorithm: these images were used for brain studies and for 3D reconstructions. A second set of slices was reconstructed with 5-mm increases and a bone algorithm to visualize the sutures of the axial plane. The 3D images were processed with the Shaded Surface Display software with threshold values ranging 120-150 HU. All images were acquired with a single spiral scan lasting less than 30 seconds. Two blinded radiologists analyzed the 3D and the planar images independently to evaluate the course and depth of each cranial suture. The sensitivity, specificity and diagnostic accuracy of both 3D and planar SCT images were evaluated. The frequency of artifacts (the Lego effect, boiled egg, pseudoforamina, movement, and chainsaw artifacts) and their influence on the final diagnosis were studied on 3D SCT images.
The diagnostic accuracy rates of 3D SCT images, by suture, were: sagittal 90.7%, metopic 100%, left lamboid 90.9%, right lamboid 93.9%, left coronal 85.7%, right coronal 91.1%. The diagnostic accuracy rates of the axial images, by suture, were: sagittal 90.7%, metopic 95.5%, left lamboid 86.4%, right lamboid 90.9%, left coronal 83.7%, right coronal 91.1%. The interobserver agreement on 3D images was: sagittal 91.1%, metopic 100%, left lamboid 88.9%, right lamboid 91.1%, left coronal 88.9%, right coronal 84.4%. The Lego effect artifact was the most frequent one (82%) and affected image evaluation in 6.3% of cases.
Our results prove that 3D SCT is a very accurate technique for identifying normal and abnormal sutures and presents many advantages over conventional 3D CT in the examination of pediatric patients with craniosynostosis. The quality of 3D SCT images was adequate and the artifacts did not affect the final diagnostic yield significantly.
Three-dimensional CT maximum intensity projection (MIP) can depict suture patency, extent of synostosis (ie, complete versus incomplete bone bridging), fracture extent and conspicuity, and 3D calvarial deformity as a single set of projections in children with suspected craniosynostosis or skull fracture. Three-dimensional CT MIP may provide, in only eight views, all the required information to make the diagnosis of craniosynostosis and calvarial fracture extent currently requiring the combined information of 3D CT shaded surface displays and 2D axial CT images (a total of 58 views), and in some cases complementary skull radiographs. Three-dimensional MIP can be added to calvarial helical (spiral) CT imaging with only 5 minutes of additional postprocessing time.
Craniosynostosis, caused by premature fusion of the sutures, may be syndromic or non-syndromic. Radiology has an important role to play in the assessment, management and follow-up of these patients. Initial investigations may often be undertaken within general radiology departments. An understanding of the terminology and recognition of the predictable patterns of presentation are essential to enable appropriate referral to a craniofacial unit where further investigation and management are undertaken. We present the radiological features of several craniosynostoses with an emphasis on the role of plain radiography. We demonstrate the complementary role of computed tomography in their evaluation within the setting of a specialist centre.
Craniosynostoses are the most frequent craniofacial malformations. However, with a prevalence of 3-6 cases per 10,000 live births they are amongst the rarely seen diseases and their definite diagnosis thus poses a challenge to the physician. When an abnormal calvarial configuration is detected, a radiological evaluation is necessary to characterize the deformity and to guide the corrective surgical procedure. The demand for clear diagnostic criteria is justified by the severity of the disease and the possible consequences of delayed diagnosis. In addition to the clinical signs (deformation of the head), conventional skull X-rays show typical radiological alterations and are used for basic diagnostics. Diagnostic tests that may be performed to confirm the diagnosis and assess the extent of the problem, include computed tomography (CT), 3D-CT, magnetic resonance imaging (MRI) scans, and ultrasonography. In the present review we will describe the most important clinical and radiological characteristics of craniosynostosis by means of clinical, radiological and operative situs examples.
Craniosynostosis is a defect of the skull caused by early fusion of one or more of the cranial sutures and affects 3 to 5 individuals per 10,000 live births. Craniosynostosis can be divided into two main groups: syndromic and nonsyndromic. Nonsyndromic craniosynostosis is typically an isolated finding that is classified according to the suture(s) involved. Syndromic craniosynostosis is associated with various dysmorphisms involving the face, skeleton, nervous system, and other anomalies and is usually accompanied by developmental delay. More than 180 syndromes exist that contain craniosynostosis. Secondary effects of craniosynostosis may include vision problems and increased intracranial pressure, among others. The molecular basis of many types of syndromic craniosynostosis is known, and diagnostic testing strategies will often lead to a specific diagnosis.
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