title: Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients With Positional Plagiocephaly: The Role of Imaging.
abstract: BACKGROUND
  No evidence-based guidelines exist for the imaging of patients with positional plagiocephaly.
  
  
  OBJECTIVE
  The objective of this systematic review and evidence-based guideline is to answer the question, Is imaging necessary for infants with positional plagiocephaly to make a diagnosis?
  
  
  METHODS
  The National Library of Medicine Medline database and the Cochrane Library were queried with the use of MeSH headings and key words relevant to imaging as a means to diagnose plagiocephaly. Abstracts were reviewed, and an evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III).
  
  
  RESULTS
  A total of 42 full-text articles were selected for review. Of these, 10 were eliminated; thus, 32 full-text were manuscripts selected. There was no Class I evidence, but 2 Class II and 30 Class III studies were included. Three-dimensional cranial topographical imaging, ultrasound, skull x-rays, computed tomography, and magnetic resonance imaging were investigated.
  
  
  CONCLUSIONS
  Clinical examination is most often sufficient to diagnose plagiocephaly (quality, Class III; strength, Level III). Within the limits of this systematic review, the evidence suggests that imaging is rarely necessary and should be reserved for cases in which the clinical examination is equivocal. Many of the imaging studies were not designed to address the diagnostic utility of the imaging modality, and authors were actually assessing the utility of the imaging in longitudinal follow-up, not initial diagnosis. For this reason, some of the studies reviewed were downgraded in Level of Evidence. When needed, 3-dimensional cranial topographical photo, skull x-rays, or ultrasound imaging is almost always sufficient for definitive diagnosis. Computed tomography scanning should not be used to diagnose plagiocephaly, but it may be necessary to rule out craniosynostosis. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_2.
authors.affiliation: *Goryeb Children's Hospital of Atlantic Health Systems, Morristown, New Jersey; ‡Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon; §Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; ¶Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida; ‖Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont; #Semmes-Murphey Neurologic & Spine Institute; Department of Neurosurgery, University of Tennessee Health Science Center, and Le Bonheur Children's Hospital, Memphis, Tennessee; **St. Louis Cleft-Craniofacial Center, SSM Health Cardinal Glennon Children's Hospital at Saint Louis University, Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri; ‡‡Department of Neurosurgery, Palmetto Health University of South Carolina Medical Group, Columbia, South Carolina; §§Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; ¶¶Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; ‖‖Advocate Children's Hospital, Oak Lawn, Illinois; ##Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; ***Department of Surgery, Division of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; ‡‡‡Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mazzola
authors.forename: Lissa C
authors.initials: LC
authors.lastname: Baird
authors.forename: David F
authors.initials: DF
authors.lastname: Bauer
authors.forename: Alexandra
authors.initials: A
authors.lastname: Beier
authors.forename: Susan
authors.initials: S
authors.lastname: Durham
authors.forename: Paul
authors.initials: P
authors.lastname: Klimo
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Lin
authors.forename: Catherine
authors.initials: C
authors.lastname: McClung-Smith
authors.forename: Laura
authors.initials: L
authors.lastname: Mitchell
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Nikas
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Tamber
authors.forename: Rachana
authors.initials: R
authors.lastname: Tyagi
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Flannery
mesh_terms: D006801:Humans; D007223:Infant; D003952:Diagnostic Imaging; D019317:Evidence-Based Medicine; D009493:Neurosurgery / Q000458:organization & administration; D049068:Plagiocephaly, Nonsynostotic / Q000000981:diagnostic imaging; D012886:Skull / Q000000981:diagnostic imaging