title: CT of Normal Developmental and Variant Anatomy of the Pediatric Skull: Distinguishing Trauma from Normality.
abstract: The use of computed tomography (CT) in clinical practice has been increasing rapidly, with the number of CT examinations performed in adults and children rising by 10% per year in England. Because the radiology community strives to reduce the radiation dose associated with pediatric examinations, external factors, including guidelines for pediatric head injury, are raising expectations for use of cranial CT in the pediatric population. Thus, radiologists are increasingly likely to encounter pediatric head CT examinations in daily practice. The variable appearance of cranial sutures at different ages can be confusing for inexperienced readers of radiologic images. The evolution of multidetector CT with thin-section acquisition increases the clarity of some of these sutures, which may be misinterpreted as fractures. Familiarity with the normal anatomy of the pediatric skull, how it changes with age, and normal variants can assist in translating the increased resolution of multidetector CT into more accurate detection of fractures and confident determination of normality, thereby reducing prolonged hospitalization of children with normal developmental structures that have been misinterpreted as fractures. More important, the potential morbidity and mortality related to false-negative interpretation of fractures as normal sutures may be avoided. The authors describe the normal anatomy of all standard pediatric sutures, common variants, and sutural mimics, thereby providing an accurate and safe framework for CT evaluation of skull trauma in pediatric patients.
authors.affiliation: From the Department of Radiology, St George's Hospital, Blackshaw Road, London SW17 0QT, England.
authors.forename: Sanjin
authors.initials: S
authors.lastname: Idriz
authors.affiliation: From the Department of Radiology, St George's Hospital, Blackshaw Road, London SW17 0QT, England.
authors.forename: Jaymin H
authors.initials: JH
authors.lastname: Patel
authors.affiliation: From the Department of Radiology, St George's Hospital, Blackshaw Road, London SW17 0QT, England.
authors.forename: Seyed
authors.initials: S
authors.lastname: Ameli Renani
authors.affiliation: From the Department of Radiology, St George's Hospital, Blackshaw Road, London SW17 0QT, England.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Allan
authors.affiliation: From the Department of Radiology, St George's Hospital, Blackshaw Road, London SW17 0QT, England.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vlahos
mesh_terms: D000058:Accidental Falls; D000293:Adolescent; D000465:Algorithms; D002648:Child; D002649:Child Abuse / Q000175:diagnosis; D002675:Child, Preschool; D002973:Cleidocranial Dysplasia / Q000175:diagnosis / Q000000981:diagnostic imaging; D055762:Cranial Fontanelles / Q000000981:diagnostic imaging / Q000254:growth & development; D003393:Cranial Sutures / Q000000981:diagnostic imaging* / Q000254:growth & development; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D007231:Infant, Newborn; D061330:Multidetector Computed Tomography / Q000379:methods; D012886:Skull / Q000000981:diagnostic imaging* / Q000254:growth & development / Q000293:injuries; D019291:Skull Base / Q000000981:diagnostic imaging / Q000254:growth & development; D012887:Skull Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed