CRANIOSYNOSTOSIS - DIAGNOSTIC-IMAGING WITH 3-DIMENSIONAL CT PRESENTATION

PURPOSE: To measure diagnostic performance and preference of two three -dimensional CT reconstruction modalities (voxel-gradient and surface- projection) displayed two ways (conventional and unwrapped) in cranios ynostosis confirmed by surgical inspection and histologic analysis of resected sutures. METHODS: High-resolution 2-mm contiguous CT sections were obtained and three-dimensional reconstruction images generated f or 25 infants and children with skull deformities before surgical trea tment of craniosynostosis. Two pediatric radiologists and two neurorad iologists first ranked images by their own preferences for diagnostic use. Then they diagnosed craniosynostosis from images presented in ran dom order and blinded. The standard of reference was inspection during surgery and histologic evaluation of excised sutures. Finally, review ers repeated their subjective preference tests. RESULTS: The least exp erienced radiologist had 100% sensitivity for all imaging modalities a nd specificities ranging from 43% to 83%. The two most experienced rad iologists performed nearly identically, with sensitivities of 96% and specificities of 100%, After performing diagnostic tasks using all ima ge types, all radiologists preferred conventional surface projections. CONCLUSION: Experienced readers can achieve nearly perfect diagnostic performance using the latest three-dimensional CT reconstruction imag es, making it a contribution to the diagnostic process. Although perfo rmance is nearly identical for all modalities, readers strongly prefer conventionally presented surface-projection images.