title: Ultrasound screening of the lambdoid suture in the child with posterior plagiocephaly.
abstract: BACKGROUND
  The child with posterior plagiocephaly may have positional molding or unilateral lambdoid synostosis. Molding responds to conservative treatment, lambdoid synostosis requires surgical reconstruction. CT is diagnostic, but uses ionizing radiation, may need sedation, and the incidence of lambdoid fusion is only 2-3%.
  
  
  OBJECTIVE
  The purpose of this prospective study was to evaluate ultrasound as a screening test of lambdoid sutural patency using CT as the reference standard.
  
  
  METHODS
  In total, 41 children having head CT examinations were enrolled over 6 months. Of those, 29 were referred for abnormal head shape and suspected synostosis, of whom two had lambdoid fusion; 12 were referred for indications not related to head shape and found to have a normal study. Ultrasound scanning and interpretation of the lambdoid sutures was performed blinded to the CT reference standard. The lambdoid suture was read as patent or fused if a hypoechoic gap could or could not be seen between the hyperechoic calvarial bones, respectively.
  
  
  RESULTS
  The mean sensitivity and specificity of ultrasound in distinguishing a patent from fused lambdoid suture by three blinded pediatric radiologists was 100% and 89%, respectively.
  
  
  CONCLUSIONS
  Sonography of the lambdoid sutures shows excellent preliminary promise as a screening test of lambdoid sutural patency.
authors.affiliation: Department of Radiology, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, 98105-0371, Seattle, WA, USA. rsze@chmc.org
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Sze
authors.forename: Marguerite T
authors.initials: MT
authors.lastname: Parisi
authors.forename: Manrita
authors.initials: M
authors.lastname: Sidhu
authors.forename: Angelisa M
authors.initials: AM
authors.lastname: Paladin
authors.forename: Anh-Vu
authors.initials: AV
authors.lastname: Ngo
authors.forename: Kristy D
authors.initials: KD
authors.lastname: Seidel
authors.forename: Ed
authors.initials: E
authors.lastname: Weinberger
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ellenbogen
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Gruss
authors.forename: Michael L
authors.initials: ML
authors.lastname: Cunningham
mesh_terms: D003393:Cranial Sutures / Q000002:abnormalities / Q000000981:diagnostic imaging*; D003398:Craniosynostoses / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography