OBJECTIVES/GOALS: Craniosynostosis is the premature fusion of one or more cranial sutures that produces brain growth constraints and typically requires surgical treatment. We present an age- and sex-specific method to evaluate surgical outcomes using non-invasive 3D photogrammetry that brings objectivity to the current approach for clinical assessment. METHODS/STUDY POPULATION: First, we created standardized head anatomy representations for 2,020 patients (1,081 males, 939 females, age 3.14 ± 3.05 years) without cranial pathology from their computed tomography (CT) images based on our previous methods. We used principal component regression stratified by sex to establish age-specific normative ranges of anatomical variability and we designed a new metric called cranial shape abnormality (CSA) index that calculates the number of standard deviations from normality of a given patient’s head anatomy. We calculated our CSA index in a group of 56 patients (44 male, 12 female) with sagittal craniosynostosis who underwent sagittal craniectomy from their pre- (22 ± 30 days before surgery) and post-surgical (267 ± 63 days after surgery) 3D photograms to evaluate surgical outcomes. RESULTS/ANTICIPATED RESULTS: We observed a reduction in the CSA index from 1.28 ± 0.26 before surgery to 0.87 ± 0.22 after surgery (p < 0.001 with a paired Wilcoxon test). The CSA index decreased in 53 of 56 patients (94.6%), who consistently showed head shape improvements after corrective surgery during clinical evaluation. Linear temporal regression indicates a CSA index decrease of 0.43 ± 0.05 during the first year after surgery. We found no significant correlation between a patient’s age at surgery and the patient’s CSA index after surgery (Pearson’s correlation coefficient 0.17, p = 0.20) or the patient’s change in CSA index before and after surgery (Pearson’s correlation coefficient 0.22, p = 0.11), suggesting that sagittal craniectomy is equally effective for all patients who are between 85 and 331 days old at the time of surgery. DISCUSSION/SIGNIFICANCE: Our new CSA index is a sex- and age-specific metric of head shape anomalies built upon the observed statistical distributions in the normative pediatric population. Our metric can objectively evaluate pre- and post-surgical head shapes and will allow the investigation of the reported variability in surgical outcomes among patients and procedures.
Background: Available normative references of cranial bone development and suture fusion are incomplete or based on simplified assumptions due to the lack of large datasets. We present a fully data-driven normative model that represents the age- and sex-specific variability of bone shape, thickness, and density between birth and 10 years of age at every location of the calvaria. Methods: The model was built using a cross-sectional and multi-institutional pediatric computed tomography image dataset with 2068 subjects without cranial pathology (age 0–10 years). We combined principal component analysis and temporal regression to build a statistical model of cranial bone development at every location of the calvaria. We studied the influences of sex on cranial bone growth, and our bone density model allowed quantifying for the first time suture fusion as a continuous temporal process. We evaluated the predictive accuracy of our model using an independent longitudinal image dataset of 51 subjects. Results: Our model achieved temporal predictive errors of 2.98 ± 0.69 mm, 0.27 ± 0.29 mm, and 76.72 ± 91.50 HU in cranial bone shape, thickness, and mineral density changes, respectively. Significant sex differences were found in intracranial volume and bone surface areas (P < 0.01). No significant differences were found in cephalic index, bone thickness, mineral density, or suture fusion. Conclusions: We presented the first pediatric age- and sex-specific statistical reference for local cranial bone shape, thickness, and mineral density changes. We showed its predictive accuracy using an independent longitudinal dataset, we studied developmental differences associated with sex, and we quantified suture fusion as a continuous process.
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