title: A Retrospective Analysis of the Utility of Head Computed Tomography and/or Magnetic Resonance Imaging in the Management of Benign Macrocrania.
abstract: To assess whether computed tomography (CT), magnetic resonance imaging (MRI), and neurosurgical evaluations altered the diagnosis or management of children diagnosed with benign macrocrania of infancy by ultrasonography (US).
  
  
  
  We queried our radiology database to identify patients diagnosed with benign macrocrania of infancy by US between 2006 and 2013. Medical records of those with follow-up CT/MRI were reviewed to determine clinical/neurologic status and whether or not CT/MRI imaging resulted in diagnosis of communicating hydrocephalus or required neurosurgical intervention.
  
  
  
  Patients with benign macrocrania of infancy (n = 466) were identified (mean age at diagnosis: 6.5 months). Eighty-four patients (18.0%) received subsequent head CT/MRI; of these, 10 patients had neurologic abnormalities before 2 years of age, of which 3 had significant findings on MRI (temporal lobe white matter changes, dysmorphic ventricles, thinned corpus callosum). One patient without neurologic abnormalities had nonspecific white matter signal abnormality (stable over 6 months) but no change in management. None required neurosurgical intervention. Another 9/84 patients had incidental findings including Chiari I (3), small subdural bleeds (2), arachnoid cyst (1), small cavernous malformation (1), frontal bone dermoid (1), and a linear parietal bone fracture after a fall (1).
  
  
  
  Children diagnosed with benign macrocrania of infancy on US without focal neurologic findings do not require subsequent brain CT/MRI or neurosurgical evaluation. Decreasing unnecessary imaging would decrease costs, minimize radiation and sedation exposures, and increase clinic availability of neurology and neurosurgery specialists.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: mchael.haws@cchmc.org.
authors.forename: M Edward
authors.initials: ME
authors.lastname: Haws
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Luke
authors.initials: L
authors.lastname: Linscott
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Cameron
authors.initials: C
authors.lastname: Thomas
authors.affiliation: University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Emily
authors.initials: E
authors.lastname: Orscheln
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Rupa
authors.initials: R
authors.lastname: Radhakrishnan
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Beth
authors.initials: B
authors.lastname: Kline-Fath
mesh_terms: D000704:Analysis of Variance; D002508:Cephalometry / Q000379:methods; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging* / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D058627:Megalencephaly / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008991:Monitoring, Physiologic; D059906:Neuroimaging / Q000379:methods*; D009460:Neurologic Examination / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D018608:Ultrasonography, Doppler / Q000706:statistics & numerical data
keywords: communicating hydrocephalus; developmental delay; external hydrocephalus; extra-axial fluid; imaging; ultrasound