Automated analysis and predictive modeling of craniosynostosis with cranial suture measurements and intracranial volume asymmetries using the snake algorithm

Quantifying the progression of a condition is one the most difficult challenges facing physicians as they look to provide the most effective treatment customized for individual patients. To achieve these goals, a novel image processing algorithm providing automated quantification has been developed to analyze the cranial vault and sutures using CT in humans and construct predictive models of the condition. Currently, very few preoperative or postoperative quantification tools exist for children with craniosynostosis so we used a customized active contour snake algorithm and 3D reconstruction to quantify the intracranial volume and measure the cranial sutures of these patients. A set of 117-patient CT scans was collected and analyzed, 77 with varying types of craniosynostosis and 40 normal patients as a control. Total intracranial volume was maintained in craniosynostosis patients in comparison to normal resulting in a uniform growth curve that showed no significant difference between the two groups. Assessing the asymmetry in the intracranial volume and measurements of suture volume and patency resulted in quantitative separations in synostosis types. These separations were further validated by a logistic regression model with pseudo R 2 values greater than 0.95 and an 86.9% average accuracy in cross-validation of the seven groups, which increased to 91.9% with the removal of the underrepresented lambdoid synostosis group.

[1]  R. Guldberg,et al.  Rapid re-synostosis following suturectomy in pediatric mice is age and location dependent. , 2013, Bone.

[2]  O. Kirmi,et al.  Craniosynostosis: a radiological and surgical perspective. , 2009, Seminars in ultrasound, CT, and MR.

[3]  J. Hinojosa,et al.  Complications in the surgical treatment of craniosynostosis and craniofacial syndromes: apropos of 306 transcranial procedures , 2008, Child's Nervous System.

[4]  A. Hockley,et al.  Intracranial volume change in childhood. , 1999, Journal of neurosurgery.

[5]  A. Wilkie Craniosynostosis: genes and mechanisms. , 1997, Human molecular genetics.

[6]  Brani Vidakovic,et al.  Statistics for Bioengineering Sciences: With MATLAB and WinBUGS Support , 2011 .

[7]  Lisa Morris,et al.  Management of Craniosynostosis , 2016, Facial Plastic Surgery.

[8]  G Duc,et al.  Anterior fontanel: size and closure in term and preterm infants. , 1986, Pediatrics.

[9]  Jeffrey R Marcus,et al.  Objective Three-Dimensional Analysis of Cranial Morphology , 2008, Eplasty.

[10]  Philippe Büchler,et al.  Feature-invariant image registration method for quantification of surgical outcomes in patients with craniosynostosis: a preliminary study. , 2011, Journal of pediatric surgery.

[11]  A. Hunter,et al.  Craniosynostosis. I. Sagittal synostosis: its genetics and associated clinical findings in 214 patients who lacked involvement of the coronal suture(s). , 1976, Teratology.

[12]  J. Panchal,et al.  The Timing of Physiologic Closure of the Metopic Suture: A Review of 159 Patients Using Reconstructed 3D CT Scans of the Craniofacial Region , 2001, The Journal of craniofacial surgery.

[13]  Robert E. Guldberg,et al.  Algorithm to Assess Cranial Suture Fusion with Varying and Discontinuous Mineral Density , 2012, Annals of Biomedical Engineering.

[14]  A. Uzun,et al.  Comparison of four methods for the estimation of intracranial volume: A gold standard study , 2007, Clinical anatomy.

[15]  D. Frim,et al.  Recurrence of Synostosis following Surgical Repair of Craniosynostosis , 2008, Plastic and reconstructive surgery.

[16]  Roger Hudgins,et al.  A Longitudinal, Statistical Study of Reoperation Rates in Craniosynostosis , 1997, Plastic and reconstructive surgery.

[17]  J. Concato,et al.  A simulation study of the number of events per variable in logistic regression analysis. , 1996, Journal of clinical epidemiology.

[18]  C. Bonaïti‐pellié,et al.  Genetic study of nonsyndromic coronal craniosynostosis. , 1995, American journal of medical genetics.

[19]  J. Hinojosa,et al.  Surgical treatment of isolated and syndromic craniosynostosis. Results and complications in 283 consecutive cases. , 2008, Neurocirugia.

[20]  S. Rasmussen,et al.  A population‐based study of craniosynostosis in metropolitan Atlanta, 1989–2003 , 2008, American journal of medical genetics. Part A.

[21]  J. Ascherman,et al.  Intracranial Volumes in a Large Series of Healthy Children , 2009, Plastic and reconstructive surgery.

[22]  H. Rekate,et al.  The effects of craniosynostosis on the brain with respect to intracranial pressure. , 2004, Seminars in pediatric neurology.

[23]  H. Pomerance,et al.  Nelson Textbook of Pediatrics. , 1997, Archives of pediatrics & adolescent medicine.