title: Use of temporal morphomic indices as a clinically important variable in the diagnosis of nonsyndromic craniosynostosis.
abstract: BACKGROUND
  Preoperative computed tomography (CT) evaluation of patients with nonsyndromic craniosynostosis (NSC) has focused on the bony cranial vault while ignoring the surrounding soft tissues. In this study, we posit that novel CT-derived temporal muscle and temporal fat pad morphomics (tissue thickness, area, and volume) can be used to calculate temporal morphomic indices (TMIs), which are unique to each NSC subtype (metopic, coronal, and sagittal) and divergent from normal individuals.
  
  
  METHODS
  High-throughput image analysis was used to reconstruct the 3-dimensional anatomy and quantify a TMI. These steps were completed in a semiautomated method using algorithms programmed in MATLAB v13.0. Differences in TMI across various craniosynostosis subtypes were assessed using Wilcoxon nonparametric tests for both patients with NSC and a control cohort of patients with trauma.
  
  
  RESULTS
  Using preoperative CT images, we evaluated 117 children with NSC from the University of Michigan Health System and 50 age-matched control patients between 1999 and 2011. Results indicate significant differences in TMI among the normal and NSC groups, with normal patients having significantly higher TMI values than patients with metopic, sagittal, and coronal synostosis. In addition, significant differences were found to exist between each craniosynostosis category.
  
  
  CONCLUSIONS
  Patients with craniosynostosis demonstrate diminished temporalis muscle and overlying fat pad volume and thickness compared with control patients. The unique changes in temporal morphomics presented in this article demonstrate not only that the bony calvaria is affected by craniosynostosis but also that there exist quantifiable aberrations in the temporalis muscle and temporal fat pad. The methodologies described offer a novel methodology to use pre-existing CT scans to glean additional preoperative information on the soft tissue characteristics of patients with craniosynostosis.
authors.affiliation: From the *Section of Plastic Surgery, Department of Surgery, and †Department of Biostatistics, University of Michigan; ‡Morphomics Analysis Group, Ann Arbor, MI; and §Department of Statistics and ∥Center for Statistical Science, Peking University, Beijing, China.
authors.forename: Jacob
authors.initials: J
authors.lastname: Rinkinen
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.forename: Jeffery
authors.initials: J
authors.lastname: Lisiecki
authors.forename: Binu
authors.initials: B
authors.lastname: Enchakalody
authors.forename: Sven
authors.initials: S
authors.lastname: Holcombe
authors.forename: Alex
authors.initials: A
authors.lastname: Dombrowski
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Wang
authors.forename: Steven R
authors.initials: SR
authors.lastname: Buchman
authors.forename: Benjamin
authors.initials: B
authors.lastname: Levi
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D003398:Craniosynostoses / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D013703:Temporal Muscle / Q000000981:diagnostic imaging* / Q000473:pathology*; D014057:Tomography, X-Ray Computed