Fusion patterns of major calvarial sutures on volume-rendered CT reconstructions

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Recently, the authors investigated the normal course of fusion of minor lateral calvarial sutures on “3D” volume-rendered head CT reconstructions in pediatric trauma patients. While evaluating these reconstructions, they found many more fused sagittal sutures than expected given the currently accepted prevalence of sagittal craniosynostosis. In the present study, using the same set of head CT reconstructions, they investigated the course of fusion of the sagittal as well as the lambdoid, coronal, and metopic sutures.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>They reviewed all volume-rendered head CT reconstructions performed in the period from 2010 through mid-2012 at Children’s Hospital Colorado for trauma patients aged 0–21 years. Each sagittal, lambdoid, coronal, or metopic suture was graded as open, partially fused, or fused. The cephalic index (CI) was calculated for subjects with fused and partially fused sagittal sutures.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>After exclusions, 331 scans were reviewed. Twenty-one subjects (6%) had fusion or partial fusion of the sagittal suture. Four of the 21 also had fusion of the medial lambdoid and/or coronal sutures. In the 17 subjects (5%) with sagittal suture fusion and no medial fusion of adjacent sutures, the mean CI was 77.6. None of the 21 subjects had been previously diagnosed with craniosynostosis. Other than in the 21 subjects already mentioned, no other sagittal or lambdoid sutures were fused at all. Nor were other coronal sutures fused medially. Coronal sutures were commonly fused inferiorly early during the 2nd decade of life, and fusion progressed superiorly and medially as subjects became older; none were completely fused by 18 years of age. Fusion of the metopic suture was first seen at 3 months of life; fusion was often not complete until after 2 years.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The sagittal and lambdoid sutures do not usually begin to fuse before 18 years of age. However, more sagittal sutures are fused before age 18 than expected given the currently accepted prevalence of craniosynostosis. This finding is of unknown significance, but likely many of them do not need surgery. The coronal suture often begins to fuse inferiorly early in the 2nd decade of life but does not usually complete fusion before 18 years of age. The metopic suture often starts to fuse by 3 months of age, but it may not completely fuse until after 2 years of age.</jats:p></jats:sec>

Application of a deep learning image reconstruction (DLIR) algorithm in head CT imaging for children to improve image quality and lesion detection

“…CT examination is fast and non-invasive and is often used to image the head for injury and convulsion in pediatric emergency care [1][2][3][4][5]. However, in pediatric CT imaging, how to minimize the CT dose and make it fit in better with the as low as reasonably achievable (ALARA) principle is always a topic worth discussing [6].…”

The 27 Facial Sutures: Timing and Clinical Consequences of Closure

“…On computed tomography, closure starts before age 7 and is complete by the teens. 109 In addition to sagittal synostosis, premature closure of the sphenoparietal and sphenosquamosal sutures may occur in scaphocephaly. 110 The sphenoparietal suture may also be synostosed in Apert because of the frontal bone's shortened orbital plate.…”

Isolated frontosphenoidal craniosynostosis: An argument for genetic testing

“…Under normal physiologic conditions, each suture fuses at a distinct chronological age. For example, the metopic suture is the only suture to fuse in early childhood, whereas the sagittal and coronal sutures typically fuse in the second decade of life and the frontosphenoidal suture fuses between 5 and 15 years of age (Wang et al, 2022; Wilkinson et al, 2020). Prior to fusion, the sutures are flexible in order to accommodate a growing brain and protect the brain from minor trauma.…”

“…Prior to fusion, the sutures are flexible in order to accommodate a growing brain and protect the brain from minor trauma. As the sutures begin to fuse, the skull become progressively immobile (Wilkinson et al, 2020). Craniosynostosis is a birth defect characterized by the premature fusion of the calvaria, disrupting the physiological process of skull development and resulting in varying degrees of skull pathology ranging from changes in skull shape, such as scaphocephaly, to severe developmental defects caused by limitation of brain growth and increase intracranial pressure (Aldridge et al, 2002; Fearon et al, 2022; Garza & Khosla, 2012; Kapp‐Simon et al, 2007).…”

“…Historically, poor imaging has led to IFSC being misdiagnosed as coronal synostosis (Francel et al, 1995). With the advent of high‐resolution 3D CT scans, minor suture craniosynostoses such as FSC are now readily identified (Calandrelli et al, 2014; Wilkinson et al, 2020). Due to phenotypic similarities, cases of IFSC reported in the literature represent incidental findings in patients who were presumed to have coronal synostosis (Hennedige et al, 2021; Magge et al, 2014; Marucci et al, 2009).…”