Binary nature and radiographic identifiability of craniosynostosis.
OBJECTIVE
Two independent gold standards and diagnoses from three-dimensional computed tomography (CT) images were used to examine the possibility that craniosynostosis is a binary abnormality that potentially may be diagnosed without error.


METHODS
Surgical reports, histology of excised sutures, and three-dimensional CT images were compared for 25 children undergoing surgical management of craniosynostosis. Surgical reports identified sutures as normal or abnormal. Histology reported suture closure on a 5-point scale. Four radiologists used three-dimensional CT images to diagnose sutures on a 6-point rated response scale.


RESULTS
Sutures with histology 0, 1, or 2 were normal on surgical reports, and those with histology 3 or 4 were abnormal. Most readers achieved nearly perfect sensitivity and specificity. Reader confidence was unrelated to degree of pathology.


CONCLUSIONS
Craniosynostosis appears to be binary in our sample. Surgical reports, pathology results, and three-dimensional CT images read by experienced viewers achieved nearly perfect agreement.
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
T K
TK
Pilgram
M W
MW
Vannier
J L
JL
Marsh
B B
BB
Kraemer
S C
SC
Rayne
M H
MH
Gado
C J
CJ
Moran
W H
WH
McAlister
G D
GD
Shackelford
R A
RA
Hardesty
D003393:Cranial Sutures / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D003398:Craniosynostoses / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003399:Craniotomy; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008297:Male; D008499:Medical Records; D015588:Observer Variation; D009777:Occipital Bone / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D010294:Parietal Bone / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*