Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.
Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
Pediatr Radiol. 2021 May;51(5):811-821. doi: 10.1007/s00247-020-04907-7. Epub 2021 Jan 5.
Macrocephaly is a common finding in infants and is often idiopathic or familial. In the absence of clinical signs and symptoms, it can be difficult to determine when concern for underlying pathology is justified.
The objectives of this study were to determine the utility of screening head ultrasound (US) in asymptomatic infants with macrocephaly and to identify clinical factors associated with significant US findings.
A 20-year retrospective review was performed of infants undergoing head US for macrocephaly or rapidly increasing head circumference. Data collected included age, gender, head circumference at birth and at the time of US, specialty of the ordering physician, US findings, computed tomography (CT) or magnetic resonance imaging (MRI) findings, and clinical course including interventions.
Four hundred and forty infants met inclusion criteria. Two hundred and eighty studies (64%) were found to be normal, 137 (31%) had incidental findings, 17 (3.8%) had indeterminate but potentially significant findings, and 6 (1.4%) had significant findings. Twenty of the 23 infants with indeterminate or significant findings had subsequent CT or MRI. This confirmed significant findings in eight infants (1.8%): three subdural hematomas, two intracranial tumors, two aqueductal stenoses, and one middle fossa cyst. Five of the eight infants required surgical procedures. The only statistically significant association found with having a significant finding on head US was head circumference at birth.
Ultrasound is a useful initial study to evaluate infantile macrocephaly, identifying several treatable causes in our study and, when negative, effectively excluding significant pathology.
大头畸形在婴儿中很常见，通常是特发性的或家族性的。在没有临床症状和体征的情况下，很难确定何时有理由担心潜在的病理。
本研究的目的是确定在无症状大头畸形婴儿中筛查头颅超声（US）的效用，并确定与显著 US 发现相关的临床因素。
对因大头畸形或头围快速增长而行头颅 US 的婴儿进行了一项 20 年的回顾性研究。收集的数据包括年龄、性别、出生时和 US 时的头围、开单医生的专业、US 结果、计算机断层扫描（CT）或磁共振成像（MRI）结果以及包括干预措施在内的临床过程。
440 名婴儿符合纳入标准。280 项研究（64%）结果正常，137 项（31%）有偶然发现，17 项（3.8%）结果不确定但可能有重要发现，6 项（1.4%）有重要发现。23 名不确定或有重要发现的婴儿中有 20 名随后进行了 CT 或 MRI。这证实了 8 名婴儿（1.8%）有重要发现：3 例硬膜下血肿，2 例颅内肿瘤，2 例导水管狭窄，1 例中颅窝囊肿。其中 5 名婴儿需要手术。唯一发现与 US 有重要发现有统计学显著关联的是出生时的头围。
超声是评估婴儿大头畸形的有用初始研究，在我们的研究中发现了几个可治疗的原因，并且当结果为阴性时，可有效地排除重要的病理。
