title: A new quantitative image-based method for evaluation of bony temporal hollowing in metopic synostosis.
abstract: OBJECTIVE
  Premature craniosynostosis is a congenital disorder causing a skull deformity. For both functional and cosmetic reasons, the deformity is surgically treated with a cranioplasty before the age of 1 year. Temporal hollowing is a common and undesirable remaining deformity after cranioplasty for metopic synostosis. The most common method to determine the degree of temporal hollowing is subjective judgement of the temporal region. The aim of the present project was to develop a quantitative semi-automatic computer tool for objective measurement of bony temporal hollowing.
  
  
  METHODS
  Using MATLAB, a tool was developed to segment computed tomography images, defining the outermost contour. The images were dorsally limited to the widest point of the head. In each case, a sex- and age-matched control was identified and the contours compared. The bony temporal hollowing of the cases was calculated.
  
  
  RESULTS
  The intra-user coefficient of variation (CV) was 5.0% (95% CI = 4.2%-6.2%) and the inter-user CV was 3.0% (95% CI = 2.1%-8.6%). For clinical testing purposes, the tool was used in 14 patients, seven of whom had been operated on with a spring-assisted cranioplasty and seven with a cranioplasty using a bone graft.
  
  
  CONCLUSIONS
  In summary, this study presents a new tool for objective measurement of the surgical result after cranioplasty for metopic synostosis.
authors.affiliation: a Department of Radiation Physics , Institute for Clinical Sciences, Sahlgrenska Academy, Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden.
authors.forename: Linn
authors.initials: L
authors.lastname: Hagmarker
authors.affiliation: b Department of Plastic Surgery , Institute for Clinical Sciences, Sahlgrenska Academy, Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden.
authors.forename: Madiha Bhatti
authors.initials: MB
authors.lastname: Söfteland
authors.affiliation: b Department of Plastic Surgery , Institute for Clinical Sciences, Sahlgrenska Academy, Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Maltese
authors.affiliation: b Department of Plastic Surgery , Institute for Clinical Sciences, Sahlgrenska Academy, Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Tarnow
authors.affiliation: a Department of Radiation Physics , Institute for Clinical Sciences, Sahlgrenska Academy, Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden.
authors.forename: Emma
authors.initials: E
authors.lastname: Wikberg
authors.affiliation: b Department of Plastic Surgery , Institute for Clinical Sciences, Sahlgrenska Academy, Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Kölby
authors.affiliation: a Department of Radiation Physics , Institute for Clinical Sciences, Sahlgrenska Academy, Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Bernhardt
mesh_terms: D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D012886:Skull / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D013701:Temporal Bone / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed
keywords: MATLAB; Metopic synostosis; computed tomography images; temporal hollowing