Medina L S, Frawley K, Zurakowski D, Buttros D, DeGrauw A J, Crone K R
Health Outcomes and Policy Section, Radiology Outcomes Center, Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH, USA.
AJNR Am J Neuroradiol. 2001 Mar;22(3):564-70.
Macrocrania is a common pediatric clinical condition affecting up to 5% of the population. The purpose of this study was to determine clinical and imaging predictors that are useful in the differentiation of disorders requiring surgical treatment from those that can be treated medically in children with macrocrania.
In a 3-year 7-month retrospective study, 88 patients (median age, 8 months; interquartile range, 5--13 months) with macrocrania and no known underlying neurologic disorder underwent imaging of the brain (sonography, n = 36; CT, n = 31; MR imaging = 21). The study was conducted in a pediatric tertiary care referral center. Clinical and imaging data were correlated to final diagnosis by means of logistic regression and receiver operating characteristic curves.
Sixteen (18%) of the patients had disorders requiring surgery: communicating hydrocephalus, n = 7; noncommunicating hydrocephalus, n = 3; hemorrhagic subdural collections, n = 3; neoplasm, n = 1; encysted cavum septi pellucidi, n = 1; and vein of Galen malformation, n = 1. Clinical predictors of disorders requiring surgery included vomiting (P =.007), labor instrumentation (P =.026), developmental delay (P =.008), and abnormal neurologic findings (P =.028). Imaging predictors of disorders requiring surgery included a focal space-occupying lesion (P <.0001) and moderate-to-severe ventriculomegaly (P <.0001). The diagnostic sensitivity of the combination of independent clinical and imaging predictors was higher than that of independent clinical predictors alone, being 100% (95% confidence interval = 96.9%, 100%) and 93.8% (95% confidence interval = 88.7%, 98.8%), respectively. A trend indicated that the area under the receiver operating characteristic curve for clinical plus imaging findings (0.95) was greater than that for clinical findings alone (0.85) (P =.09). An increase in the number of clinical and imaging predictors was highly correlated with an increased risk of a disorder requiring surgery (P <.0001).
Baseline neuroimaging is indicated for children with macrocrania because the combination of clinical and imaging predictors has the best diagnostic performance in determining the need for surgical versus nonsurgical management.
巨头畸形是一种常见的儿科临床病症，影响着高达5%的人群。本研究的目的是确定临床和影像学预测指标，这些指标有助于区分需要手术治疗的疾病与可通过药物治疗的巨头畸形患儿的疾病。
在一项为期3年7个月的回顾性研究中，88例（中位年龄8个月；四分位间距5 - 13个月）巨头畸形且无已知潜在神经系统疾病的患者接受了脑部成像检查（超声检查，n = 36；CT，n = 31；磁共振成像，n = 21）。该研究在一家儿科三级医疗转诊中心进行。通过逻辑回归和受试者操作特征曲线将临床和影像学数据与最终诊断相关联。
16例（18%）患者患有需要手术治疗的疾病：交通性脑积水，n = 7；非交通性脑积水，n = 3；出血性硬膜下积液，n = 3；肿瘤，n = 1；透明隔囊肿，n = 1；大脑大静脉畸形，n = 1。需要手术治疗疾病的临床预测指标包括呕吐（P = 0.007）、产时器械助产（P = 0.026）、发育迟缓（P = 0.008）和异常神经系统表现（P = 0.028）。需要手术治疗疾病的影像学预测指标包括局灶性占位性病变（P < 0.0001）和中重度脑室扩大（P < 0.0001）。独立临床和影像学预测指标联合的诊断敏感性高于单独的独立临床预测指标，分别为100%（95%置信区间 = 96.9%，100%）和93.8%（95%置信区间 = 88.7%，98.8%）。一种趋势表明，临床加影像学表现的受试者操作特征曲线下面积（0.95）大于单独临床发现的曲线下面积（0.85）（P = 0.09）。临床和影像学预测指标数量的增加与需要手术治疗疾病的风险增加高度相关（P < 0.0001）。
巨头畸形患儿应进行基线神经影像学检查，因为临床和影像学预测指标联合在确定手术与非手术治疗需求方面具有最佳诊断性能。
