X-ray VS. CT Scans

[Matthews Mommy]

British Journal of Neurosurgery
Publisher: Taylor & Francis
Issue: Volume 16, Number 4 / August 01, 2002
Pages: 348 - 354
URL: Linking Options
DOI: 10.1080/0268869021000007560

Are routine preoperative CT scans necessary in the management of single suture craniosynostosis?


S. Cerovac , J. G. Neil-Dwyer , P. Rich , B. M. Jones , R. D. Hayward

Abstract:

CT scanning is accepted as a regular component of the investigation of patients with simple craniosynostosis. In a series of 109 cases with simple craniosynostoses treated at Great Ormond Street Hospital for Children, a correct diagnosis on the basis of clinical findings was made in 100% of cases by an experienced clinician. CT scans with 3D reconstructions provided diagnostic confir mation in 100% of the patients when performed, but 91 % of patients had already had sufficient confirmation of diagnosis by radiography. The clinical use of the scans for purposes other than diagnosis was examined. CT scanning in simple craniosynostosis in this series did not provide any additional clinical benefit as a screening method for the detection of intracranial abnormalities or for surgical planning. We propose that it may be appropriate to limit CT scanning, both axial images and three dimensional reconstructions, to selected cases where diagnostic uncertainty exists or where, it is used in surgical planning.

[Katie]

Thank you for that information, it makes a lot of sense. Dillon's case was described as "unique" by his NS, so I'm guessing that's why the X-ray wasn't 100% accurate in his case. I'll add though, that even though the X-ray did not show all the fusions that the CT did, it did give us a starting point with at least one fusion.

[craniomommynbaby]

Thanks for that article. Even though Simon had 2 sutures fused, I do not think that Simon's surgeons really needed the CT scan for diagnosis. His pedi sent us for x-rays before we even met the surgeons, and those confirmed the pedi's suspicions of bicoronal cranio. The surgeons could see what was wrong right away by just looking at him. We ended up with 2 CT scans anyhow. The first one ended up being too early before the surgery, so we did a second one about 1 month before the surgery to help the surgeons plan. I have always wondered if the scans were really necessary at all, except for the planning.

[ExpatJen]

Thank you for this! I have agonized over the use of CT scans too. Audrey ended up having 2 - one before to find out if surgery was still possible (to see if sinuses had developed) and one a few days after the surgery - but other than having a picture of what was done, I do not know if that 2nd scan was necessary. I know that when she fell and got a huge egg on her head a few weeks after the surgery the doctors looked at that 2nd scan to see exactly what was under the bump - which, although right over the incision, was fortunately outside the area where the repairs were made. So I suppose that was useful but it certainly wasn't a predictable use. I asked about any other CTs planned for the future at her last check-up a week ago and was told that the only reason another would be done would be for curiosity and that they would never do one just for curiosity.

I think it would be a good idea to have some tips on CT scans on this site like we do on what to bring to the hospital and what quesitons to ask the surgeons. For example, parents should be advised that CTs for children should be performed with machines that can actually be calibrated for children and not on "adult-only" machines. I am torn, though, on CTs not being used for diagnosis because x-rays do not always catch fused sutures, which was the case with Audrey and was the main reason she was misdiagnosed as a baby. But even that error could have been avoided if she, along with the x-ray, had been sent to a neurologist and not just the x-ray (I will never understand why her pedi. did that).

-Jennifer C.

[saraweise]

I feel pretty dumb about this.

Is one preferred over the other? My son was diagnosed without either (x-ray or CT) however the ns stated he wanted a CT before the surgery to rule out “any surprises”. Joseph was pretty textbook with the bitemporal narrowing, and frontal bossing which I guess is the reason for immediate diagnosis (sagittal craniosynostosis).

[Mom2William]

I am not sure how I feel about the CT scan either. I know William will have another CT at one year to check the healing.

We are also in a study with Duke for the CT's using less radiation therefore the scans will be less clear to read-- and this is to "test" the radiologists to see if they can still be accurate in diagnosing. Will's original CT scans will be made to be less clear for the Radio. Docs to read and give diagnosis then compare to the originals.

Anyway, the 3D scans do show the brain within the skull to show signs of pressure when the xrays cannot show the brain. So,...I still do not know which is better or more necessary. That's just my two cents worth.

[Jennifer]

I feel pretty dumb about this.

Is one preferred over the other? My son was diagnosed without either (x-ray or CT) however the ns stated he wanted a CT before the surgery to rule out “any surprises”. Joseph was pretty textbook with the bitemporal narrowing, and frontal bossing which I guess is the reason for immediate diagnosis (sagittal craniosynostosis).


Emily was also diagnosed w/o one, but one was done before the surgery 'just to see what we're getting into'. I was never really worried about the exposure- it is really minimal overall (Tracey- Holly's mom had a statisitic on it- I can't recall it now) I don't thing many NS's would request a X-ray due to the little amount of info it can give them.....

Oh-- please don't ever feel dumb about this cranio stuff.....most of us aren't 'trained' in advance and have no knowledge as we begin the journey....you learn as you go and what you don't know we're here to help (if we know:giggle)

[Katie]

I feel pretty dumb about this.

Is one preferred over the other? My son was diagnosed without either (x-ray or CT) however the ns stated he wanted a CT before the surgery to rule out “any surprises”. Joseph was pretty textbook with the bitemporal narrowing, and frontal bossing which I guess is the reason for immediate diagnosis (sagittal craniosynostosis).

Dillon was also diagnosed with craniosynostosis before his CT by his appearance, but because his case was "unique" they wanted a CT scan. The initial X-ray was not wrong about unilateral coronal fusion, but it didn't pick up the other two fusions which his surgeons knew were fused by the ridging. They needed a "map" for the surgery and a 3D CT was the best route to go in Dillon's case, plus they needed to rule out ICP. I'm guessing it would really have to do with the complexity of the case and weather or not it was a straight forward unquestionable fusion. He also had one a week and a half after surgery to see how things were healing, and several since. We know Dillon will be having another surgery, so the extra CT's are to see how he is progressing and how long the next surgery can be put off.
Man that was a long winded reply :lol

[plukids]

Sylvie was also diagnosed by appearance but the NS wanted the 3D CT to be definitive. We did not have an xray. Interesting article....thanks for sharing it!!