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MDCT Diagnosis of the Child with Posterior Plagiocephaly

¹ Department of Radiology, University of Washington, 4800 Sand Point Way NE, PO Box 5371/CH-69, Seattle, WA 98105-0371.
² Department of Plastic Surgery, University of Washington, Seattle, WA 98105-0371.
³ Department of Neurosurgery, University of Washington, Seattle, WA 98105-0371.
⁴ Children's Craniofacial Center, Children's Hospital and Regional Medical Center, Seattle, WA 98105.

View larger version (129K): [in a new window]   Fig. 1A —Endocranial skull base views show basioccipital (B), paired exoccipital (E), supraoccipital (S), and interparietal (I) portions of occipital bone. Surrounding synchondroses include spheno-occipital (small solid arrows), anterior intraoccipital (large solid arrow), posterior intraoccipital (solid arrowhead), petrooccipital (open arrowheads), and occipitomastoid (open arrows). Mendosal sutures (small solid arrowheads) mark junction between membranous and endocranial portions of occipital bone. Image shows portions of occipital bone and surrounding synchondroses in 3-week-old boy. k = Kerckring ossicle.

View larger version (128K): [in a new window]   Fig. 1B —Endocranial skull base views show basioccipital (B), paired exoccipital (E), supraoccipital (S), and interparietal (I) portions of occipital bone. Surrounding synchondroses include spheno-occipital (small solid arrows), anterior intraoccipital (large solid arrow), posterior intraoccipital (solid arrowhead), petrooccipital (open arrowheads), and occipitomastoid (open arrows). Mendosal sutures (small solid arrowheads) mark junction between membranous and endocranial portions of occipital bone. Image shows portions of occipital bone, fusion of mendosal sutures, and narrowing but preserved patency of multiple skull base synchondroses in 10-month-old girl.

View larger version (116K): [in a new window]   Fig. 2A —10-month-old boy with posterior deformational plagiocephaly. Posterior view of volume reformations shows normal, flat posterior skull base and normal-appearing skull shape.

View larger version (107K): [in a new window]   Fig. 2B —10-month-old boy with posterior deformational plagiocephaly. Vertex view of volume reformation shows parallelogram shape of skull with parallel relationship between frontal and posterior convexities.

View larger version (116K): [in a new window]   Fig. 2C —10-month-old boy with posterior deformational plagiocephaly. Endocranial skull base view shows no deviation in anterior skull base axis line (bisecting cribriform plate) and posterior skull base axis (connecting basion and opisthion).

View larger version (68K): [in a new window]   Fig. 2D —10-month-old boy with posterior deformational plagiocephaly. Axial CT scan shows asymmetric flattening of right posterior skull but patency of bilateral lambdoid sutures. Note that perisutural thickening (arrowhead) is not sign of suture fusion.

View larger version (119K): [in a new window]   Fig. 3A —3-month-old boy with left unilateral lambdoid synostosis. Posterior view of volume reformation shows left lambdoid suture fusion and ipsilateral skull base tilt. Also note parallelogram shape on this posterior view due to ipsilateral occipitomastoid bossing and contralateral parietal bulge.

View larger version (113K): [in a new window]   Fig. 3B —3-month-old boy with left unilateral lambdoid synostosis. Vertex view of volume reformation shows characteristic trapezoid shape with convergence of frontal and posterior convexities toward side of left lambdoid fusion.

View larger version (123K): [in a new window]   Fig. 3C —3-month-old boy with left unilateral lambdoid synostosis. Endocranial skull base view shows significant deviation of intersecting anterior cranial fossa and posterior cranial fossa axis lines, with posterior fossa twisted toward side of left lambdoid fusion.

View larger version (69K): [in a new window]   Fig. 3D —3-month-old boy with left unilateral lambdoid synostosis. Axial CT scan shows bone fusion of left lambdoid suture. Right lambdoid suture (arrowhead) is patent. Note that end-to-end morphology of suture is not sign of suture fusion.

View larger version (119K): [in a new window]   Fig. 4A —3-month-old boy with right lambdoid fusion modified by prominent communicating mendosal sutures. Posterior volume reformation shows fusion of lateral half of right lambdoid suture (open arrow) and prominent mendosal sutures (solid arrows) meeting in midline, giving impression of duplicated lambdoid suture. Skull base cant expected from unilateral lambdoid synostosis has been minimized by patent mendosal sutures.

View larger version (128K): [in a new window]   Fig. 4B —3-month-old boy with right lambdoid fusion modified by prominent communicating mendosal sutures. Right posterior oblique view of volume reformation shows fusion of lateral right lambdoid and prominent bulge over right mendosal suture.

View larger version (121K): [in a new window]   Fig. 4C —3-month-old boy with right lambdoid fusion modified by prominent communicating mendosal sutures. Endocranial skull base view shows bulge over patent right mendosal suture and only minimal deviation of relationship between anterior and posterior skull base axis lines.

View larger version (119K): [in a new window]   Fig. 5A —6-month-old girl with premature fusion of posterior intraoccipital synchondrosis. Posterior view of volume reformation shows prominent left inferior skull base cant not associated with lambdoid suture fusion.

View larger version (133K): [in a new window]   Fig. 5B —6-month-old girl with premature fusion of posterior intraoccipital synchondrosis. Endocranial skull base view shows leftward deviation of posterior skull base axis lines. Right posterior intraoccipital synchondrosis is prematurely fused and not visible. Normal, patent left posterior intraoccipital synchondrosis (arrowhead) is well seen.

View larger version (68K): [in a new window]   Fig. 5C —6-month-old girl with premature fusion of posterior intraoccipital synchondrosis. Axial CT image shows how difficult this diagnosis would be to make without volumetric endocranial skull base views. Patent left intraoccipital synchondrosis (arrowheads) is seen for only very short segments because it is in plane with axial slices.

View larger version (68K): [in a new window]   Fig. 5D —6-month-old girl with premature fusion of posterior intraoccipital synchondrosis. Axial CT image does show right posterior intraoccipital synchondrosis is fused; however, this can be determined only by directed interrogation of its expected course in posterior skull base (arrowhead).

View larger version (99K): [in a new window]   Fig. 6A —3-year-old girl with premature fusion of anterior intraoccipital synchondrosis. Posterior view of volume reformation shows left inferior skull base cant without lambdoid suture fusion.

View larger version (113K): [in a new window]   Fig. 6B —3-year-old girl with premature fusion of anterior intraoccipital synchondrosis. Endocranial skull base view shows leftward deviation of posterior skull base axis lines and subtle fusion of anterior intraoccipital synchondrosis (arrow).

View larger version (121K): [in a new window]   Fig. 6C —3-year-old girl with premature fusion of anterior intraoccipital synchondrosis. Magnified inferior view of occipital bone shows partial fusion of left anterior intraoccipital synchondrosis (open arrow) and patent right anterior intraoccipital synchondrosis (solid arrow).

View larger version (72K): [in a new window]   Fig. 6D —3-year-old girl with premature fusion of anterior intraoccipital synchondrosis. Axial CT image confirms premature fusion of most medial aspect of left anterior intraoccipital synchondrosis with cortical thickening (open arrow). Normal right anterior intraoccipital synchondrosis (solid arrow) is widely patent.

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