title: Effectiveness of screening for craniosynostosis with ultrasound: a retrospective review.
abstract: BACKGROUND
  Minimizing the ionizing radiation dose to children is fundamental to pediatric radiology. The most widely accepted imaging examination for evaluating craniosynostosis is computed tomography (CT) of the head, an examination that involves ionizing radiation.
  
  
  OBJECTIVE
  To determine if sonography of the cranial sutures is an adequate screening examination for the diagnosis of craniosynostosis in patients with abnormal skull shape.
  
  
  METHODS
  A retrospective review of all cranial suture ultrasound (US) examinations performed during the course of a 3-year period (July 2012 - September 2015) was undertaken. Results were compared with clinical follow-up and/or head CT to evaluate the accuracy of this modality as a screening tool to determine the presence or absence of craniosynostosis. Fifty-two sonographic exams were adequate for inclusion.
  
  
  RESULTS
  Forty-five of the examinations did not reveal synostosis. In each of these instances, follow-up physical exam findings and/or CT imaging confirmed that no abnormal premature suture closure was present. US findings demonstrated synostosis in seven cases. CT exam or operative reports of these cases confirmed all seven findings of premature suture closure. Statistical analysis demonstrated a sensitivity of 100% (95% confidence interval [CI]: 56.1-100.0%), a specificity of 100% (95% CI: 90.2-100.0%), and a negative predictive value of 100% (95% CI: 90.2-100.0%).
  
  
  CONCLUSIONS
  Cranial US is a reliable screening tool to rule out craniosynostosis in patients with abnormal head shape.
authors.affiliation: Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA. hallkenm@gmail.com.
authors.forename: Kent M
authors.initials: KM
authors.lastname: Hall
authors.affiliation: Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Besachio
authors.affiliation: Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Moore
authors.affiliation: Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA.
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Mora
authors.affiliation: Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Carter
mesh_terms: D003393:Cranial Sutures / Q000000981:diagnostic imaging*; D003398:Craniosynostoses / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
keywords: Children; Cranial sutures; Craniosynostosis; Plagiocephaly; Skull; Ultrasound