CT Imaging Findings after Craniosynostosis Reconstructive Surgery

Ginat, Daniel Thomas; Lam, Daniel T.; Kuhn, Andrew S.; Reid, Russell R.

doi:10.1159/000489175

Cited by 10 publications

(6 citation statements)

References 19 publications

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“…Although CTs are commonly ordered to evaluate postoperative complications, such as bleeding, infection, hardware failure, and hydrocephalus, 12 our survey specifically eliminated the possibility of complications when asking about postoperative CT utilization. Calvarial defects are also frequently evaluated using CT, 20,21 but our survey similarly disallowed this possibility, as further evaluation of large defects with imaging is assumed. In the absence of late complications, large calvarial defects, and the development of signs and symptoms concerning for ICH, patients with nonsyndromic craniosynostosis do not require imaging postoperatively 12 .…”

Section: Discussionmentioning

confidence: 98%

Computed Tomography in Patients With Craniosynostosis

et al. 2021

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Background In patients with craniosynostosis, imaging remains up to the discretion of the plastic surgeon or neurosurgeon. To inform best practice guidelines, we sought to obtain data surrounding the frequency at which craniofacial surgeons order computed tomography (CT), as well as indications. We hypothesized that we would identify considerable variation in both imaging and associated indications. Methods We surveyed members of the American Society of Maxillofacial Surgeons and the American Society of Craniofacial Surgeons to measure the frequency of preoperative and postoperative head CTs, as well as indications. Initial items were piloted with 2 craniofacial surgeons and 1 neurosurgeon, using interviews to ensure content validity. χ2 Tests were used to measure associations between operative volume, years in practice, and imaging. Results Eighty-five craniofacial surgeons responded (13.8% response rate), with the majority (63.5%) having performed a craniosynostosis operation in the last month. Only 9.4% of surgeons never order preoperative CTs. Of those who do, the most common indications included diagnosis confirmation (31.2%) and preoperative planning (27.3%). About 25% of surgeons always obtain postoperative head CTs, usually to evaluate surgical outcomes (46.7%). Only 13.3% of respondents order 2 or more postoperative scans. Higher operative volume was associated with a lower likelihood of ordering preoperative head CTs (P = 0.008). Conclusions The majority of surgeons obtain preoperative head CTs, whereas only 25% obtain CTs postoperatively, often to evaluate outcomes. Because outcomes may be evaluated clinically, this is a poor use of resources and exposes children to radiation. Consensus guidelines are needed to create best practices and limit unnecessary studies.

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Section: Discussionmentioning

confidence: 98%

Computed Tomography in Patients With Craniosynostosis

et al. 2021

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“…To this day, many craniofacial centers still rely on CT scans for the diagnostic assessment of cranial deformity [25,26], and primary or secondary medical care units often lack the expertise to distinguish positional deformities from craniosynostosis with certainty. Recognizing the efficacy of convolutional neural networks (CNNs) and deep learning (DL) in medical image analysis, particularly in radiology [27,28], we aim to leverage these technologies for classifying pathological growth patterns in craniosynostosis.…”

Section: Introductionmentioning

confidence: 99%

The Use of Artificial Intelligence for the Classification of Craniofacial Deformities

Kuehle,

Ringwald,

Bouffleur

et al. 2023

JCM

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Positional cranial deformities are a common finding in toddlers, yet differentiation from craniosynostosis can be challenging. The aim of this study was to train convolutional neural networks (CNNs) to classify craniofacial deformities based on 2D images generated using photogrammetry as a radiation-free imaging technique. A total of 487 patients with photogrammetry scans were included in this retrospective cohort study: children with craniosynostosis (n = 227), positional deformities (n = 206), and healthy children (n = 54). Three two-dimensional images were extracted from each photogrammetry scan. The datasets were divided into training, validation, and test sets. During the training, fine-tuned ResNet-152s were utilized. The performance was quantified using tenfold cross-validation. For the detection of craniosynostosis, sensitivity was at 0.94 with a specificity of 0.85. Regarding the differentiation of the five existing classes (trigonocephaly, scaphocephaly, positional plagiocephaly left, positional plagiocephaly right, and healthy), sensitivity ranged from 0.45 (positional plagiocephaly left) to 0.95 (scaphocephaly) and specificity ranged from 0.87 (positional plagiocephaly right) to 0.97 (scaphocephaly). We present a CNN-based approach to classify craniofacial deformities on two-dimensional images with promising results. A larger dataset would be required to identify rarer forms of craniosynostosis as well. The chosen 2D approach enables future applications for digital cameras or smartphones.

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“…Even in the setting of acute ventriculoperitoneal (VP) shunt dysfunction, options such as “quick brain” MRI have been recommended, given the suboptimal sensitivity of CTs (Yue et al, 2015). Despite this, a considerable number of surgeons obtain postoperative CTs for uncertain clinical indications, such as complication surveillance or assessment of calvarial morphology (Jo et al, 2019; Ginat et al, 2018; Mundinger et al, 2018), incurring radiation exposure and significant cost (Brenner and Hall, 2007; “Uninsured—Image Pricing,” 2018).…”

Section: Introductionmentioning

confidence: 99%

Variation in the Utilization of Postoperative Computed Tomography for Patients With Nonsyndromic Craniosynostosis: A National Claims Analysis

Makar

Gunaseelan

Waljee

et al. 2019

The Cleft Palate-Craniofacial Journal

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Objective: Routine postoperative computed tomography (CT) imaging in nonsyndromic craniosynostosis remains controversial due to the hazards of radiation exposure. The extent to which postoperative head CTs are performed remains unknown. Therefore, we sought to measure the use of postoperative CTs in this population. Design: The authors reviewed insurance claims from OptumInsight, using Current Procedural Terminology codes to identify procedures and postoperative imaging. Multilevel logistic regression was used to describe the odds of undergoing postoperative CTs, adjusting for patient and provider covariates. Participants: Craniosynostosis patients who underwent reconstruction between 2001 and 2017 were reviewed. Patients older than 5 years at surgery, postoperative lengths of stay >15 days, syndromic diagnoses, operative complications within 30 days of surgery, and cranial bone grafting merited exclusion. Main Outcome Measure: Odds of postoperative head CTs after cranial vault reconstruction. Results: In this cohort (n = 1150), 326 (28.4%) patients underwent postoperative head CTs. The number of CTs ranged from 0 to 14. Older age at surgery (odds ratio [OR]: 1.32, P = .002), increasing years of follow-up (OR: 1.12, P < .001), and increasing comorbidities (OR: 1.21, P = .017) were associated with postoperative CTs. After adjusting for patient factors, provider factors accounted for 31.3% of variation in imaging. Conclusions: Over a quarter of patients underwent head CTs following reconstruction, and provider factors accounted for a large percentage of the variation. Given the risks of radiation, neurosurgeons and craniofacial surgeons face a critical need to establish postoperative imaging protocols to reduce unnecessary imaging in these vulnerable patients.

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CT Imaging Findings after Craniosynostosis Reconstructive Surgery

Cited by 10 publications

References 19 publications

Computed Tomography in Patients With Craniosynostosis

Computed Tomography in Patients With Craniosynostosis

The Use of Artificial Intelligence for the Classification of Craniofacial Deformities

Variation in the Utilization of Postoperative Computed Tomography for Patients With Nonsyndromic Craniosynostosis: A National Claims Analysis

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