To compare the various imaging modalities in the diagnosis and management of children with craniosynostosis

Objectives Craniosynostosis is a common malformation occurring in 1 per 10,000 live births. Non-syndromic craniosynostosis is the premature fusion of the cranial sutures. The present study evaluated the clinical correlation of suture involvement with 99mTc-ECD SPECT/CT, X-ray, NCCT and MRI in all cases of non-syndromic craniosynostosis.

Methods We retrospectively analyzed a total of fifty patients for non-syndromic craniosynostosis from 2007 to 2012. All patients underwent 99mTc-ECD SPECT/CT examination and the results were correlated with radiological and surgical findings. IRB approved the study and informed consent form was obtained from all patients.

Results Out of 50 patients, 32 were boys and 18 were girls (age, 16- 38 months). Observed detection rates were 96%, 68%, 82%, 72%, using SPECT/CT, X-ray, NCCT and MRI respectively. Combination of NCCT and SPECT/CT revealed sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 80.5%, 19.5%, 18.2%, 8.3% respetively. Combination of X-ray and SPECT/CT showed sensitivity, specificity, PPV and NPV of 75%, 8.1%, 90.9%, and 100% respectively. However, combination of MRI and SPECT/CT revealed a high sensitivity, PPV and NPV of 85.7%, 100%, 75%, respectively but with low specificity of 14.3%. Hence, our results indicated that 99mTc-ECD SPECT/CT alone or its combination with MRI may provide better management in non-syndromic craniosynostosis. 99mTc-ECD SPECT/CT revealed regional hypoperfusion in the cerebral hemisphere in preoperative patients of craniosynostosis, corresponding to the fused sutures while postoperative studies revealed disappearance of these perfusion abnormalities.

Conclusions The present study showed that 99mTc-ECD SPECT/CT provides improved diagnosis and patients management of non-syndromic craniosynostosis as compare to other conventional imaging modalities