HIGH-RESOLUTION SONOGRAPHY OF THE ABNORMAL CRANIAL SUTURE

Objective. The purpose of this investigation is to elucidate the sonog raphic features of abnormal major cranial sutures. Materials and metho ds. Eight excised synostosed suture specimens were evaluated. The high -resolution sonographic appearance was correlated with the histologica l section, plain radiographs, CT and MRI. Diastatic and molded sutures were also evaluated with sonography and compared with the normal cran ial suture appearance. Results. Synostosed sutures demonstrated one or more of the following features: (a) loss of echo-poor fibrous gap bet ween bony plates (five sagittal and coronal synostoses); (b) irregular thickened inner sutural margin (three lambdoid synostoses); (c) loss of bevelled edge (one lambdoid synostosis); (d) asymmetric anterior fo ntanelle (one coronal synostosis). Cranial molding results in an overl ap of echogenic bony plates. Sutural width (the distance between bony plates) is increased in cases of elevated intracranial pressure. Concl usion. Sonography is an inexpensive, radiation-free modality which can confirm synostosis versus molding versus an underlying intracranial l esion as a cause of plagiocephaly. The high-resolution sonographic ima ges also provide a relatively easy means to assess sutural width and m ay provide information in regard to increased intracranial pressure.