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• W4319161127 abstract "PURPOSE: Premature closure of the sagittal suture causes restricted growth perpendicular to the suture line and compensatory changes including temporal narrowing, frontal bossing, occipital bulletting, scaphocephalic head shape, and lowering of the vertex. This study assesses the ability of a novel photogrammetric diagnostic angle, largely based on cranial vertex position, to reliably distinguish sagittal craniosynostosis (SS) from control and false positive cases (SNS). MATERIALS AND METHODS: All head CT imaging at our institution between 2014-2020 was reviewed for patients with sagittal synostosis (SS, n =177), presumed sagittal synostosis with normal imaging (n=30), and controls (n = 100). A novel measurement reflecting the anterior-posterior location of the vertex was measured by an angle drawn between the cranial vertex, nasion, and opisthocranion (VNO) in profile view with the head in a neutral position. This VNO angle was measured on 307 3D head CTs and 172 lateral clinical photos using NilRead Viewer and Microsoft PowerPoint respectively. Cranial index (CI) was measured on axial pre-operative head CTs. A threshold to determine maximum diagnostic sensitivity and specificity of the VNO angle was established based on receiver operating characteristic (ROC) curve analysis. Logistic regression was used to assess the ability of VNO angle to predict true SS diagnosis. RESULTS: Mean age at pre-operative head CT was 9.5 months for the SS cohort, 4.2 months for the SNS cohort, and 8.9 months for controls (p=.327). Mean age at pre-operative clinical photo was 9.5 months for the SS cohort and 4.2 months for the SNS cohort (p=.149). The average VNO angle measured on clinical photos was 54.7° ±3.8° for the SS group, 43.1° ±2.2° for the SNS group, and 41.1° ±3.7° for controls (p<.001). Pearson correlations revealed no significant association between VNO angle and age at scan or age at clinical photo for any group (p = .232 - .924). Evaluation of standardized clinical photos revealed frontal bossing in 66% of SS patients (n = 104), 17% of SNS patients (n = 3), and zero controls. Occipital bulleting was present in 43% of SS patients (n = 83), 33% of SNS patients (n = 6), and zero controls. Receiver operating characteristic (ROC) analysis yielded a cut-off of ≥ 50° to identify SS. Diagnostic sensitivity and specificity were 96.6% and 99.2% respectively. Lastly, a logistic regression analysis to investigate the ability of a VNO angle ≥50° to predict a diagnosis of SS revealed a 95.3 times greater likelihood of having sagittal synostosis with a VNO angle greater than or equal to 50° [Exp (B) = .047]. The unstandardized Beta weight for the predictor variable was B = 8.198, S.E. = 1.086, Wald = 56.938, p < .001. ROC analyses including FB, OCB, and CI measurements were not as sensitive or specific as VNO angle alone. CONCLUSION: Measurement of the VNO angle is a reliable screening tool to diagnose sagittal craniosynostosis, with an angle ≥50° strongly suggesting suture synostosis. This method relies on the relationship between the anterior displacement of the vertex and occipital bulleting to approach the diagnostic accuracy of CT imaging." @default.
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• W4319161127 date "2022-10-01" @default.
• W4319161127 modified "2023-09-25" @default.
• W4319161127 title "A Novel Angle to Reliably Diagnose Sagittal Craniosynostosis" @default.
• W4319161127 doi "https://doi.org/10.1097/01.gox.0000898984.74519.1c" @default.
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