title: Cranial Ultrasound as a First-Line Imaging Examination for Craniosynostosis.
abstract: BACKGROUND
  Radiography, typically the first-line imaging study for diagnosis of craniosynostosis, exposes infants to ionizing radiation. We aimed to compare the accuracy of cranial ultrasound (CUS) with radiography for the diagnosis or exclusion of craniosynostosis.
  
  
  METHODS
  Children aged 0 to 12 months who were assessed for craniosynostosis during 2011-2013 by using 4-view skull radiography and CUS of the sagittal, coronal, lambdoid, and metopic sutures were included in this prospective study. Institutional review board approval and parental informed consent were obtained. CUS and radiography were interpreted independently and blindly by 2 pediatric radiologists; conflicts were resolved in consensus. Sutures were characterized as closed, normal, or indeterminate. Correlation between CUS and radiography and interreader agreement were examined for each suture.
  
  
  RESULTS
  A total of 126 children (82 boys, 64.5%) ages 8 to 343 days were included. All sutures were normal on CUS and radiography in 115 patients (93.7%); craniosynostosis of 1 suture was detected in 8 (6.3%, 5 sagittal, 2 metopic, 1 coronal). In 3 cases the metopic suture was closed (n = 2) or indeterminate on CUS (n = 1) but normally closed on radiography. CUS sensitivity was 100%, specificity 98% (95% confidence interval 94%-100%). Reader agreement was 100% for sagittal, coronal, and lambdoid sutures (κ = 0.80); after consensus, disagreement remained on 3 metopic sutures.
  
  
  CONCLUSIONS
  In this series, CUS could be safely used as a first-line imaging tool in the investigation of craniosynostosis, reducing the need for radiographs in young children. Additional assessment may be required for accurate assessment of the metopic suture.
authors.affiliation: Department of Medical Imaging, and Department of Diagnostic Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel katro70@yahoo.com.
authors.forename: Katya
authors.initials: K
authors.lastname: Rozovsky
authors.affiliation: Department of Medical Imaging, and.
authors.forename: Kristin
authors.initials: K
authors.lastname: Udjus
authors.affiliation: Department of Medical Imaging, and.
authors.forename: Nagwa
authors.initials: N
authors.lastname: Wilson
authors.affiliation: Research Institute, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; and.
authors.forename: Nicholas James
authors.initials: NJ
authors.lastname: Barrowman
authors.affiliation: Department of Diagnostic Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Natalia
authors.initials: N
authors.lastname: Simanovsky
authors.affiliation: Department of Medical Imaging, and.
authors.forename: Elka
authors.initials: E
authors.lastname: Miller
mesh_terms: D003398:Craniosynostoses / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D012886:Skull / Q000000981:diagnostic imaging*; D014463:Ultrasonography