title: What's in a Name? Accurately Diagnosing Metopic Craniosynostosis Using a Computational Approach.
abstract: BACKGROUND
  The metopic suture is unlike other cranial sutures in that it normally closes in infancy. Consequently, the diagnosis of metopic synostosis depends primarily on a subjective assessment of cranial shape. The purpose of this study was to create a simple, reproducible radiographic method to quantify forehead shape and distinguish trigonocephaly from normal cranial shape variation.
  
  
  METHODS
  Computed tomography scans were acquired for 92 control patients (mean age, 4.2 ± 3.3 months) and 18 patients (mean age, 6.2 ± 3.3 months) with a diagnosis of metopic synostosis. A statistical model of the normal cranial shape was constructed, and deformation fields were calculated for patients with metopic synostosis. Optimal and divergence (simplified) interfrontal angles (IFA) were defined based on the three points of maximum average deformation on the frontal bones and metopic suture, respectively. Statistical analysis was performed to assess the accuracy and reliability of the diagnostic procedure.
  
  
  RESULTS
  The optimal interfrontal angle was found to be significantly different between the synostosis (116.5 ± 5.8 degrees; minimum, 106.8 degrees; maximum, 126.6 degrees) and control (136.7 ± 6.2 degrees; minimum, 123.8 degrees; maximum, 169.3 degrees) groups (p < 0.001). Divergence interfrontal angles were also significantly different between groups. Accuracy, in terms of available clinical diagnosis, for the optimal and divergent angles, was 0.981 and 0.954, respectively.
  
  
  CONCLUSIONS
  Cranial shape analysis provides an objective and extremely accurate measure by which to diagnose abnormal interfrontal narrowing, the hallmark of metopic synostosis. The simple planar angle measurement proposed is reproducible and accurate, and can eliminate diagnostic subjectivity in this disorder.
  
  
  METHODS
  Diagnostic, IV.
authors.affiliation: Washington, D.C. From the Division of Plastic and Reconstructive Surgery, Children's National Health System; the Division of Plastic Surgery, George Washington University School of Medicine and Health Sciences; Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System; and the Departments of Radiology and Pediatrics, School of Medicine and Health Sciences, George Washington University.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Wood
authors.forename: Carlos S
authors.initials: CS
authors.lastname: Mendoza
authors.forename: Albert K
authors.initials: AK
authors.lastname: Oh
authors.forename: Emmarie
authors.initials: E
authors.lastname: Myers
authors.forename: Nabile
authors.initials: N
authors.lastname: Safdar
authors.forename: Marius G
authors.initials: MG
authors.lastname: Linguraru
authors.forename: Gary F
authors.initials: GF
authors.lastname: Rogers
mesh_terms: D016022:Case-Control Studies; D002508:Cephalometry / Q000379:methods; D003393:Cranial Sutures / Q000000981:diagnostic imaging; D003398:Craniosynostoses / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*