title: Craniosynostosis: diagnostic imaging with three-dimensional CT presentation.
abstract: OBJECTIVE
  To measure diagnostic performance and preference of two three-dimensional CT reconstruction modalities (voxel-gradient and surface-projection) displayed two ways (conventional and unwrapped) in craniosynostosis confirmed by surgical inspection and histologic analysis of resected sutures.
  
  
  METHODS
  High-resolution 2-mm contiguous CT sections were obtained and three-dimensional reconstruction images generated for 25 infants and children with skull deformities before surgical treatment of craniosynostosis. Two pediatric radiologists and two neuroradiologists first ranked images by their own preferences for diagnostic use. Then they diagnosed craniosynostosis from images presented in random order and blinded. The standard of reference was inspection during surgery and histologic evaluation of excised sutures. Finally, reviewers repeated their subjective preference tests.
  
  
  RESULTS
  The least experienced radiologist had 100% sensitivity for all imaging modalities and specificities ranging from 43% to 83%. The two most experienced radiologists performed nearly identically, with sensitivities of 96% and specificities of 100%. After performing diagnostic tasks using all image types, all radiologists preferred conventional surface projections.
  
  
  CONCLUSIONS
  Experienced readers can achieve nearly perfect diagnostic performance using the latest three-dimensional CT reconstruction images, making it a contribution to the diagnostic process. Although performance is nearly identical for all modalities, readers strongly prefer conventionally presented surface-projection images.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110.
authors.forename: M W
authors.initials: MW
authors.lastname: Vannier
authors.forename: T K
authors.initials: TK
authors.lastname: Pilgram
authors.forename: J L
authors.initials: JL
authors.lastname: Marsh
authors.forename: B B
authors.initials: BB
authors.lastname: Kraemer
authors.forename: S C
authors.initials: SC
authors.lastname: Rayne
authors.forename: M H
authors.initials: MH
authors.lastname: Gado
authors.forename: C J
authors.initials: CJ
authors.lastname: Moran
authors.forename: W H
authors.initials: WH
authors.lastname: McAlister
authors.forename: G D
authors.initials: GD
authors.lastname: Shackelford
authors.forename: R A
authors.initials: RA
authors.lastname: Hardesty
mesh_terms: D000465:Algorithms; D003196:Computer Graphics; D003393:Cranial Sutures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003398:Craniosynostoses / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008297:Male; D012984:Software; D014057:Tomography, X-Ray Computed / Q000379:methods*