BINARY NATURE AND RADIOGRAPHIC IDENTIFIABILITY OF CRANIOSYNOSTOSIS

RATIONALE AND OBJECTIVES. Two independent gold standards and diagnoses from three-dimensional computed tomography (CT) images mere used to e xamine the possibility that craniosynostosis is a binary abnormality t hat potentially may be diagnosed without error. METHODS. Surgical repo rts, histology of excised sutures, and three-dimensional CT images wer e compared for 25 children undergoing surgical management of craniosyn ostosis. Surgical reports identified sutures as normal or abnormal. Hi stology reported suture closure on a 5-point scale. Four radiologists used three-dimensional CT images to diagnose sutures on a 6-point rate d response scale. RESULTS. Sutures with histology 0, 1, or 2 were norm al on surgical reports, and those with histology 3 or 4 were abnormal. Most readers achieved nearly perfect sensitivity and specificity. Rea der confidence was unrelated to degree of pathology. CONCLUSION. Crani osynostosis appears to be binary in our sample. Surgical reports, path ology results, and three-dimensional CT images read by experienced vie wers achieved nearly perfect agreement.