Occipital sutures and its variations: the value of 3D-CT and how to differentiate it from fractures using 3D-CT?

The anatomy and embryology of occipital bone are complex and may present with a varied ossification pattern and masquerade as fractures. There are only a few articles in the literature and none on CT appearance of occiput ossification and sutures. Awareness of the normal and variant anatomy, appearance and position along with age of fusion of sutures will be helpful in confidently differentiating variant suture from fracture. This will be particularly important in children in the field of non-accidental injury with its attendant medicolegal complications. We describe the normal anatomy, embryology, normal and variant sutures of occipital bone as published in the literature so far and present a pictorial review of 15 cases of variant sutures. With CT as the primary modality in assessing for head injury now, it is important to know the CT features of these sutures, their appearance, position and variants and be able to utilize 3D-CT to be able to give a more definitive diagnosis.