Comparison of Black-Bone MRI and 3D-CT in the preoperative evaluation of patients with craniosynostosis

Abstract Purpose Black-Bone (BB) magnetic resonance imaging (MRI) is a non-ionizing imaging method and a recent alternative to computed tomography (CT) in the examination of cranial deformities. The purpose of this study was to compare BB-MRI and routine 3D-CT in the preoperative evaluation of patients with craniosynostosis. Methods At our centre we have routinely performed preoperative CT of the skull and brain MRI for patients with clinical suspicion of craniosynostosis. We recently changed our MRI protocol into one that includes sequences for evaluation of both brain anatomy and skull bone and sutures by BB-MRI. A semi-automatic skull segmentation algorithm was developed to facilitate the visualization. Both BB-MRI and 3D-CT were performed on 9 patients with clinical craniosynostosis and the images were evaluated by two craniofacial surgeons, one paediatric neurosurgeon, and two neuroradiologists. Results We obtained informative 3D images using BB-MRI. Six (6/9) patients had scaphocephaly, 1 (1/9) patient had unicoronal synostosis, and 2 (2/9) patients had lambdoid synostosis. Affected synostotic sutures could be identified both by BB-MRI and 3D-CT in all patients. Intrarater and interrater reliability for rating the calvarial sutures was high. However, the reliability for rating the intracranial impressions was low by both imaging methods. Conclusion BB-MRI is an alternative to 3D-CT in preoperative evaluation of patients with craniosynosytosis. BB-MRI not only provides information on cranial sutures and intracranial impressions but also on brain structure in one imaging session. This method can replace ionizing radiation-based methods in analysing skull deformities.