“Black Bone” MRI: a potential alternative to CT with three-dimensional reconstruction of the craniofacial skeleton in the diagnosis of craniosynostosis

AbstractObjectivesTo determine the potential of novel gradient echo parameters, “Black Bone” MRI as an alternative to CT in the identification of normal and prematurely fused cranial sutures both in 2D and 3D imaging.MethodsThirteen children with a clinical diagnosis of craniosynostosis underwent “Black Bone” MRI in addition to routine cranial CT. “Black Bone” datasets were compared to CT and clinical findings. “Black Bone” imaging was subsequently used to develop 3D reformats of the craniofacial skeleton to enhance further visualisation of the cranial sutures.ResultsPatent cranial sutures were consistently identified on “Black Bone” MRI as areas of increased signal intensity. In children with craniosynostosis the affected suture was absent, whilst the remaining patent sutures could be visualised, consistent with CT and clinical findings. Segmentation of the “Black Bone” MRI datasets was successful with both threshold and volume rendering techniques. The cranial sutures, where patent, could be visualised throughout their path.ConclusionsPatent cranial sutures appear as areas of increased signal intensity on “Black Bone” MRI distinct from the cranial bone, demonstrating considerable clinical potential as a non-ionising alternative to CT in the diagnosis of craniosynostosis.Key Points• Patent cranial sutures appear hyperintense on “Black Bone” MRI • Prematurely fused cranial sutures are distinct from patent sutures • Minimal soft tissue contrast permits 3D-rendered imaging of the craniofacial skeleton