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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.

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Five neonates who were born at term and who had well-defined cystic lesions in the subependymal germinal matrix demonstrated by real-time cranial ultrasonography are reported. None had evidence of subependymal or intraventricular hemorrhage. Two of the neonates had congenital viral infections, one each with rubella virus and cytomegalovirus. Two of the other three neonates died, and pathologic examination of their brains confirmed the presence of the cysts and showed no evidence of prior subependymal hemorrhage. Cranial CT examinations of three patients failed to detect the subependymal cysts. Although central liquefaction in an area of prior hemorrhage is probably the most common cause of subependymal cyst formation in neonates, other conditions such as neurotropic infection should also be considered.