CT-like MR-derived Images for the Assessment of Craniosynostosis and other Pathologies of the Pediatric Skull

Abstract

Purpose To evaluate the diagnostic value of CT-like images based on a 3D T1-weighted spoiled gradient echo-based sequence (T1SGRE) for the visualization of the pediatric skull and the identification of pathologies, such as craniosynostosis or fractures. Methods In this prospective study, 20 patients with suspected craniosynostosis (mean age 1.26 ± 1.38 years, 10 females) underwent MR imaging including the T1SGRE sequence and 2 more patients were included who presented with skull fractures (0.5 and 6.3 years, both male). Additionally, the skull of all patients was assessed using radiography or CT in combination with ultrasound. Two radiologists, blinded to the clinical information, evaluated the CT-like images. The results were compared to the diagnosis derived from the other imaging modalities and intraoperative findings. Intrarater and interrater agreement was calculated using Cohen’s κ. Results Of the 22 patients 8 had a metopic, 4 a coronal and 2 a sagittal craniosynostosis and 2 patients showed a complex combination of craniosynostoses. The agreement between the diagnosis based on the T1SGRE and the final diagnosis was substantial (Cohen’s κ = 0.92, 95% confidence interval (CI) 0.77–1.00 for radiologist 1 and κ = 0.76, CI 0.51–1.00 for radiologist 2). Of the patients with fractures, one presented with a ping pong fracture and one with a fracture of the temporal bone. Both radiologists could identify the fractures using the T1SGRE. Conclusion The visualization of the pediatric skull and the assessment of sutures using a CT-like T1SGRE MR-sequence is feasible and comparable to other imaging modalities, and thus may help to reduce radiation exposure in pediatric patients. The technique may also be a promising imaging tool for other pathologies, such as fractures.

Editorial for “Comparing CT‐Like Images Based on Ultra‐Short Echo Time and Gradient Echo T1‐Weighted MRI Sequences for the Assessment of Vertebral Disorders Using Histology and True CT as the Reference Standard”

“…3 Also, pediatric patients are vulnerable to high radiation exposures. 4 MRI is a noninvasive and radiation-free imaging modality that offers CT-like images acquired with advanced imaging techniques. A previous study established a link between the thickness of the cartilaginous endplate and disc degeneration using CT-like images in LBP patients.…”

“…The ability has already been demonstrated in the evaluation of the minute details like the fractures and suture lines in the skull. 4 In addition to offering information on osseous structures (trabeculae), these high-resolution images also reveal injuries to the nearby soft tissues. They can also gather information about the mineralization of the tumor matrix and soft tissue expansion.…”

“…Other limitations of CT-like imaging sequences include longer image acquisition times. 4 The long acquisition period results in some sensitivity to motion artifacts. The UTE sequence is also susceptible to small-fat blurring.…”

“…However, there is a considerable amount of radiation associated with CT, which is harmful for radiosensitive organs and tissues 3 . Also, pediatric patients are vulnerable to high radiation exposures 4 . MRI is a noninvasive and radiation‐free imaging modality that offers CT‐like images acquired with advanced imaging techniques.…”

“…Due to their accurate detection capability, CT‐like images have been used for assessment of the osseous and cartilaginous structures of the human spine. The ability has already been demonstrated in the evaluation of the minute details like the fractures and suture lines in the skull 4 . In addition to offering information on osseous structures (trabeculae), these high‐resolution images also reveal injuries to the nearby soft tissues.…”