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Use of black-bone MRI in the diagnosis of the patients with posterior plagiocephaly

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Abstract

Purpose

Ionising radiation exposure is especially harmful to brain development. The purpose of this study was to evaluate whether black-bone (BB) magnetic resonance imaging (MRI), a non-ionising imaging method, offers an alternative to ionising imaging methods such as computed tomography (CT) in the examination of cranial deformities.

Methods

From 2012 to 2014, a total of 408 children were referred to the Craniofacial Centre at the Helsinki University Hospital for further examination due to flatness of the posterior skull. Fifteen of these patients required further diagnostic imaging. To avoid ionising radiation, we used an MRI protocol that included sequences for evaluation of both brain anatomy and skull bone and sutures by BB-MRI. A semi-automatic skull segmentation algorithm was developed to facilitate the visualisation. Two patients with scaphocephaly were included in the study to confirm the ability to differentiate synostosis with BB-MRI.

Results

We obtained informative 3D images using BB-MRI. Seven patients (7/15, 46.7%) had plagiocephaly on the right side and seven on the left side (7/15, 46.7%). One patient (1/15, 6.7%) had symmetric posterior flatness affecting both sides. Neither structural nor signal-intensity alterations of the brain were detected in visual analysis.

Conclusion

BB-MRI provides an alternative to CT when imaging craniofacial deformities. BB-MRI provides not only high-quality 3D-reconstructed imaging of the bony structures and sutures but also information on brain structure in one imaging session. With further development, this method could replace ionising radiation-based methods in analysing deformities of the skull.

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References

  1. Garza RM, Khosla RK (2012) Nonsyndromic craniosynostosis. Semin Plast Surg 26:53–63. https://doi.org/10.1055/s-0032-1320063

    Article  PubMed  PubMed Central  Google Scholar 

  2. Brooks ED, Beckett JS, Yang J, Timberlake AT, Sun AH, Chuang C, Persing JA (2018) The etiology of neuronal development in craniosynostosis: a working hypothesis. J Craniofac Surg 29(1):49–55. https://doi.org/10.1097/SCS.0000000000004040

    Article  PubMed  Google Scholar 

  3. Kolar JC (2011) An epidemiological study of nonsyndromal craniosynostosis. J Craniofac Surg 22(1):47–49

    Article  PubMed  Google Scholar 

  4. Rhodes JL, Tye GW, Fearon JA (2014) Craniosynostosis of the lambdoid suture. Semin Plast Surg 28:138–143. https://doi.org/10.1055/s-0034-1384809

    Article  PubMed  PubMed Central  Google Scholar 

  5. Leland AA, Byrd RP (1981) Suture pathology in craniosynostosis. J Neurosurg 54:384–387. https://doi.org/10.3171/jns.1981.54.3.0384

    Article  Google Scholar 

  6. McKinney CM, Cunningham ML, Holt VL, Leroux B, Starr JR (2009) A case-control study of infant, maternal and perinatal characteristics associated with deformational plagiocephaly. Paediatr Perinat Epidemiol 23:332–345. https://doi.org/10.1111/j.1365-3016.2009.01038.x

    Article  PubMed  Google Scholar 

  7. Peitsch WK, Keefer CH, LaBrie RA, Mulliken JB (2002) Incidence of cranial asymmetry in healthy newborns. Pediatrics 110:e72

    Article  PubMed  Google Scholar 

  8. Bialocerkowski AE, Vladusic SL, Wei Ng C (2008) Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review. Dev Med Child Neurol 50:577–586. https://doi.org/10.1111/j.1469-8749.2008.03029.x

    Article  PubMed  Google Scholar 

  9. Pogliani L, Mameli C, Fabiano V, Zuccotti GV (2011) Positional plagiocephaly: what the pediatrician needs to know. A review. Childs Nerv Syst 27(11):1867–1876. https://doi.org/10.1007/s00381-011-1493-y

    Article  PubMed  Google Scholar 

  10. Hurmerinta K, Kiukkonen A, Hukki J, Saarikko A, Leikola J (2015) Lambdoid synostosis versus positional posterior plagiocephaly: a comparison of skull base and shape of calvarium using computed tomography imaging. J Craniofac Surg 26:1917–1922. https://doi.org/10.1097/SCS.0000000000002098

    Article  PubMed  Google Scholar 

  11. Ranganathan K, Rampazzo A, Hashmi A, Muraszko K, Strahle J, Vercler CJ, Buchman SR (2018) The role of preoperative imaging in the management of nonsyndromic lambdoid craniosynostosis. J Craniofac Surg 29(1):36–39. https://doi.org/10.1097/SCS.0000000000004026

    Article  PubMed  Google Scholar 

  12. Speltz ML, Collet BR, Stott-Miller M, Starr J, Heike C, Wolfram-Aduan AM, King D, Cunningham ML (2009) Case-control study of neurodevelopment in deformational Plagiocephaly. Pediatrics 2010 125(3):e537–e542. https://doi.org/10.1542/peds.2009-0052

    Article  Google Scholar 

  13. Korpilahti P, Saarinen P, Hukki J (2012) Deficient language acquisition in children with single suture craniosynostosis and deformational posterior plagiocephaly. Childs Nerv Syst 28(3):419–425. https://doi.org/10.1007/s00381-011-1623-6

    Article  PubMed  Google Scholar 

  14. Frush DP, Donnelly LF, Rosen NS (2003) Computed tomography and radiation risks: what pediatric health care providers should know. Pediatrics 112:951–957. https://doi.org/10.1542/peds.112.4.951

    Article  PubMed  Google Scholar 

  15. Kaasalainen T, Palmu K, Lampinen A, Reijonen V, Leikola J, Kivisaari R, Kortesniemi M (2015) Limiting CT radiation dose in children with craniosynostosis: phantom study using model-based iterative reconstruction. Pediatr Radiol 45:1544–1553. https://doi.org/10.1007/s00247-015-3348-2

    Article  PubMed  Google Scholar 

  16. Montoya JC, Eckel LJ, DeLone DR, Kotsenas AL, Diehn F, Yu L, Bartley AC, Carter RE, McCollough C, Fletcher J (2017) Low-dose CT for craniosynostosis: preserving diagnostic benefit with substantial radiation dose reduction. AJNR Am J Neuroradiol 38:672–677. https://doi.org/10.3174/ajnr.A5063

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  17. Schweitzer T, Böhm H, Meyer-Marcotty P, Collmann H, Ernestus R-I, Krauss JK et al (2012) Avoiding CT scans in children with single-suture craniosynostosis. Childs Nerv Syst 28:1077–1082. https://doi.org/10.1007/s00381-012-1721-0

    Article  PubMed  CAS  Google Scholar 

  18. Mazzola C, Baird LC, Bauer DF, Beier A, Durham S, Klimo P, Lin AY, McClung-Smith C, Mitchell L, Nikas D, Tamber MS, Tyagi R, Flannery AM (2016) Congress of neurological surgeons systematic review and evidence-based guideline for the diagnosis of patients with positional plagiocephaly: the role of imaging. Neurosurgery 79:E625–E626. https://doi.org/10.1227/NEU.0000000000001427 www.neurosurgery-online.com

    Article  PubMed  Google Scholar 

  19. Eley KA, AG MI, Watt-Smith SR, Golding SJ (2012) “Black bone” MRI: a partial flip angle technique for radiation reduction in craniofacial imaging. Br J Radiol 85:272–278. https://doi.org/10.1259/bjr/95110289

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Eley KA, Watt-Smith SR, Golding SJ (2012) “Black bone” MRI: a potential alternative to CT when imaging the head and neck: report of eight clinical cases and review of the Oxford experience. Br J Radiol 85:1457–1464. https://doi.org/10.1259/bjr/16830245

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Eley KA, Watt-Smith SR, Sheerin F, Golding SJ (2014) “Black bone” MRI: a potential alternative to CT with three-dimensional reconstruction of the craniofacial skeleton in the diagnosis of craniosynostosis. Eur Radiol 24:2417–2426. https://doi.org/10.1007/s00330-014-3286-7

    Article  PubMed  Google Scholar 

  22. Eley KA, Watt-Smith SR, Golding SJ (2013) “Black bone” MRI: a potential non-ionizing method for three-dimensional cephalometric analysis—a preliminary feasibility study. Dentomaxillofac Radiol 42:20130236. https://doi.org/10.1259/dmfr.20130236

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Eley KA, Sheerin F, Taylor N, Watt-Smith SR, Golding SJ (2013) Identification of normal cranial sutures in infants on routine magnetic resonance imaging. J Craniofac Surg 24:317–320. https://doi.org/10.1097/SCS.0b013e318275edee

    Article  PubMed  Google Scholar 

  24. Eley KA, Watt-Smith SR, Golding SJ (2017) Three-dimensional reconstruction of the craniofacial skeleton with gradient echo magnetic resonance imaging (“black bone”): what is currently possible? J Craniofac Surg 28:463–467. https://doi.org/10.1097/SCS.0000000000003219

    Article  PubMed  Google Scholar 

  25. Eley KA, Watt Smith SR, Golding SJ (2017) “Black bone” MRI: a novel imaging technique for 3D printing. Dentomaxillofac Radiol 46:20160407. https://doi.org/10.1259/dmfr.20160407

    Article  PubMed  PubMed Central  Google Scholar 

  26. Dixon WT (1984) Simple proton spectroscopic imaging. Radiology 153:189–194. https://doi.org/10.1148/radiology.153.1.6089263

    Article  PubMed  CAS  Google Scholar 

  27. Fei B, Yang X, Nye JA, Aarsvold JN, Raghunath N, Cervo M, Stark R, Meltzer CC, Votaw JR (2012) MR/PET quantification tools: registration, segmentation, classification, and MR-based attenuation correction. Med Phys 39:6443–6454. https://doi.org/10.1118/1.4754796

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hsu S-H, Cao Y, Huang K, Feng M, Balter JM (2013) Investigation of a method for generating synthetic CT models from MRI scans of the head and neck for radiation therapy. Phys Med Biol 58:8419–8435. https://doi.org/10.1088/0031-9155/58/23/8419

    Article  PubMed  Google Scholar 

  29. Woolrich MW, Jbabdi S, Patenaude B, Chappell M, Makni S, Behrens T, Beckmann C, Jenkinson M, Smith SM (2009) Bayesian analysis of neuroimaging data in FSL. NeuroImage 45:S173–S186. https://doi.org/10.1016/j.neuroimage.2008.10.055

    Article  PubMed  Google Scholar 

  30. Smith SM, Jenkinson M, Woolrich MW, Beckmann CF, Behrens TEJ, Johansen-Berg H, Bannister PR, De Luca M, Drobnjak I, Flitney DE, Niazy RK, Saunders J, Vickers J, Shang Y, De Stefano N, Brady JM, Matthews PM (2004) Advances in functional and structural MR image analysis and implementation as FSL. NeuroImage 23(Suppl 1):S208–S219. https://doi.org/10.1016/j.neuroimage.2004.07.051

    Article  PubMed  Google Scholar 

  31. Otsu N (1979) A threshold selection method from gray-level histograms. IEEE Trans Syst Man Cybern 9:62–66. https://doi.org/10.1109/TSMC.1979.4310076

    Article  Google Scholar 

  32. Ahmed MN, Yamany SM, Mohamed NA, Farag AA (1999) A modified fuzzy C-means algorithm for MRI bias field estimation and adaptive segmentation. In: Medical image computing and computer-assisted intervention—MICCAI’99. Springer Berlin, Heidelberg, pp 72–81

    Chapter  Google Scholar 

  33. Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin J-C, Bauer C, Jennings D, Fennessy F, Sonka M, Buatti J, Aylward S, Miller JV, Pieper S, Kikins R (2012) 3D Slicer as an image computing platform for the quantitative imaging network. Magn Reson Imaging 30:1323–1341. https://doi.org/10.1016/j.mri.2012.05.001

    Article  PubMed  PubMed Central  Google Scholar 

  34. Tustison NJ, Avants BB, Cook PA, Zheng Y, Egan A, Yushkevich PA, Gee JC (2010) N4ITK: improved N3 bias correction. IEEE Trans Med Imaging 29:1310–1320. https://doi.org/10.1109/TMI.2010.2046908

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kirmi O, Lo SJ, Johnson D, Anslow P (2009) Craniosynostosis: a radiological and surgical perspective. Semin Ultrasound CT MRI 30(6):492–512

    Article  Google Scholar 

  36. National Cancer Institute (2012) Radiation risks and pediatric computed tomography (CT): a guide for health care providers. www.cancer.gov/cancertopics/causes/radiation-risks-pediatric-ct)

  37. Engel M, Castrillon-Oberndorfer G, Hoffmann J, Freudlsperger C (2012) Value of preoperataive imaging in the diagnostics of isolated metopic suture synostosis: a risk-benefit analysis. J Plast Reconstr Aesthet Surg 65(9):1246–1251

    Article  PubMed  Google Scholar 

  38. Fearon JA, Singh DJ, Beals SP, Yu JC (2007) The diagnosis and treatment of single-sutural synostoses: are computed tomographic scan necessary? Plast Reconstr Surg 120(5):1327–1331

    Article  PubMed  CAS  Google Scholar 

  39. Petrantonaki M, Thomas M, Damilakis J (2005) MRI techniques for the examination of trabecular bone structure. Curr Med Imaging Rev 1:35–41. https://doi.org/10.2174/1573405052953038

    Article  Google Scholar 

  40. Vanel D (2003) MRI of bone metastases: the choice of the sequence. Cancer Imaging 4:30–35. https://doi.org/10.1102/1470-7330.2003.0029

    Article  Google Scholar 

  41. Watanabe A, Kinouchi H, Horikoshi T, Uchida M, Ishigame K (2008) Effect of intracranial pressure on the diameter of the optic nerve sheath. J Neurosurg 109:255–258. https://doi.org/10.3171/JNS/2008/109/8/0255

    Article  PubMed  Google Scholar 

  42. Yuan L, Kadlub N, da Silva Freitas R, Persing JA, Duncan C, Shin JH (2008) The misdiagnosis of craniosynostosis as deformational plagiocephaly. J Craniofac Surg 19(1):132–136

    Article  Google Scholar 

  43. Cinalli G, Spennato P, Sainte-Rose C, Arnaud E, Aliberti F, Brunelle F, Cianciulli E, Renier D (2005) Chiari malformation in craniosynostosis. Childs Nerv Syst 21:889–901. https://doi.org/10.1007/s00381-004-1115-z

    Article  PubMed  Google Scholar 

  44. Andropoulos DB, Greene MF (2017) Anesthesia and developing brains—implications of the FDA warning. N Engl J Med 376:905–907. https://doi.org/10.1056/NEJMp1700196

    Article  PubMed  Google Scholar 

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Funding

This study was supported by the Special Governmental Funding allocated to Helsinki University Hospital.

Author information

Author notes

  1. Linda Kuusela and Ada Hukki contributed equally to this work.

Authors and Affiliations

  1. Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland

    Linda Kuusela, Nina Brandstack & Taina Autti

  2. Department of Physics, University of Helsinki, Helsinki, Finland

    Linda Kuusela

  3. Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Central Hospital, Topeliuksenkatu 3-5, PO Box 266, 00029, Helsinki, Finland

    Ada Hukki, Junnu Leikola & Anne Saarikko

Authors
  1. Linda Kuusela
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  2. Ada Hukki
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  3. Nina Brandstack
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  4. Taina Autti
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  5. Junnu Leikola
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  6. Anne Saarikko
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Contributions

Kuusela Linda: writing, development of imaging protocol, and analysis of patient material.

Hukki Ada: writing, collecting patient material, and analysis of patient material.

Brandstack Nina: radiologist, analysis of patient material, and writing.

Autti Taina: study design and writing.

Leikola Junnu: collecting patient material and writing.

Saarikko Anne: study design, collecting patient material, and writing.

Corresponding author

Correspondence to Anne Saarikko.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Kuusela, L., Hukki, A., Brandstack, N. et al. Use of black-bone MRI in the diagnosis of the patients with posterior plagiocephaly. Childs Nerv Syst 34, 1383–1389 (2018). https://doi.org/10.1007/s00381-018-3783-0

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  • DOI: https://doi.org/10.1007/s00381-018-3783-0

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