CT Prevention In Sagittal Craniosynostosis: The Clinical Utility Of 3D- Photography As A Diagnostic Tool

Purpose: Computed tomography (CT) is the gold standard for diagnosing craniosynostosis. Despite the known risks of pediatric radiation exposure and possible sedation or general anesthesia, CT imaging is indicated for all cases of suspected craniosynostosis, regardless of clinical examination findings. The present study evaluates the potential reduction in CT scans that could be achieved by utilizing 3D-photography as a diagnostic tool for sagittal craniosynostosis (SC).Methods: Surface-based indices describing cranial morphology were extracted from 3D-photographs of individuals ages 0 to 18 months who were suspected of SC and referred by craniofacial surgeons for CT between 2018 and 2025. To evaluate their utility as a primary screening tool and their ability to confirm a diagnosis, "rule-out" and "rule-in" index thresholds were created, respectively, and applied to the study population. Results: 3D and CT imaging was obtained for identified patients suspected of SC (n = 115). A two-step diagnostic model was designed and applied to the study population to evaluate its utility in the clinical setting. Applying "rule-out" and "rule-in" index thresholds could have prevented 73.04% (84/115) of CTs (sensitivity = 100%; specificity = 99.52%). For patients who did not meet threshold criteria, SC diagnosis was excluded if the index percentile scores totaled 10 or less (sensitivity = 97.78%). Overall, this model could have prevented CTs in 77.39% (89/115) of patients. Conclusions: 3D photography provides accurate, objective measurements that reliably distinguish between patients with and without SC. Utilizing 3D-photography as a point-of-care screening tool would relegate diagnostic CT imaging to only those who are most difficult to diagnose. Without replacing their role in surgical planning, diagnostic CT scans could be reserved for a much narrower subset of patients with borderline phenotypes. *Source: https://ps-rc.org/meeting/Program/2026/24.cgi*