Fearon Jeffrey A, Singh Davinder J, Beals Stephen P, Yu Jack C
Dallas, Texas; Philadelphia, Pa.; Phoenix, Ariz.; and Augusta, Ga. From the Craniofacial Center, Medical City; Division of Plastic Surgery, University of Pennsylvania; The Southwest Craniofacial Center; and Division of Plastic Surgery, Medical College of Georgia.
Plast Reconstr Surg. 2007 Oct;120(5):1327-1331. doi: 10.1097/01.prs.0000279477.56044.55.
Computed tomographic scan evaluation is the current standard of care for diagnosing craniosynostosis. Recent publications, and the National Cancer Institute, have raised concerns about ionizing radiation associated with computed tomographic scans in children (e.g., developmental delays, tumor induction). The authors sought to ascertain the diagnostic accuracy of the physical examination in evaluating single-sutural craniosynostosis and assess the need for computed tomographic scans in surgical correction.
This prospective, multicenter, outcome assessment included children clinically diagnosed with a single-sutural synostosis by craniofacial surgeons (with 1 to 18 years' experience) at four centers over a 1-year period. Clinical diagnoses were compared with computed tomographic scan evaluations. All surgeons scored the utility of computed tomographic scans during surgical repair.
Sixty-seven patients were clinically diagnosed with single-sutural craniosynostosis (mean age, 7 months; range, 1 week to 48 months). Sixty-six of 67 patients were diagnosed with craniosynostosis by computed tomographic scan (sagittal, 40 percent; metopic, 31 percent; right unilateral coronal, 16 percent; left unilateral coronal, 6 percent; and right lambdoid, 6 percent), for a diagnostic accuracy exceeding 98 percent. One patient with suspected lambdoid synostosis was radiologically diagnosed with positional plagiocephaly. Three of four craniofacial surgeons scored computed tomographic scans as "unnecessary" for surgical correction; one scored scans as "sometimes helpful."
Craniofacial surgeons with various experience levels were able to accurately diagnose single-sutural synostosis by physical examination alone. Considering potential side effects from ionizing radiation, risks of sedation, and costs, surgeons may wish to reserve computed tomographic scans only for infants with suspected single-sutural craniosynostosis in whom the physical examination is not clearly diagnostic.
计算机断层扫描评估是目前诊断颅缝早闭的标准治疗方法。最近的出版物以及美国国立癌症研究所都对儿童计算机断层扫描所涉及的电离辐射表示担忧（例如发育迟缓、诱发肿瘤）。作者试图确定体格检查在评估单缝颅缝早闭中的诊断准确性，并评估手术矫正中进行计算机断层扫描的必要性。
这项前瞻性、多中心结局评估纳入了在1年时间内由四个中心的颅面外科医生（有1至18年经验）临床诊断为单缝颅缝早闭的儿童。将临床诊断与计算机断层扫描评估结果进行比较。所有外科医生对手术修复过程中计算机断层扫描的实用性进行评分。
67例患者临床诊断为单缝颅缝早闭（平均年龄7个月；范围1周龄至48个月）。67例患者中有66例通过计算机断层扫描诊断为颅缝早闭（矢状缝，40%；额缝，31%；右侧单侧冠状缝，16%；左侧单侧冠状缝，6%；右侧人字缝，6%），诊断准确率超过98%。1例疑似人字缝早闭的患者经放射学诊断为体位性斜头畸形。四位颅面外科医生中有三位将计算机断层扫描评为手术矫正“不必要”；一位将扫描评为“有时有帮助”。
不同经验水平的颅面外科医生仅通过体格检查就能准确诊断单缝颅缝早闭。考虑到电离辐射的潜在副作用、镇静风险和成本，外科医生可能希望仅对体格检查不能明确诊断的疑似单缝颅缝早闭婴儿保留计算机断层扫描检查。
