Cranial bone thickness and density anomalies quantified from CT images can identify chronic increased intracranial pressure

• Published in: Neuroradiology Vol. 66; no. 10; pp. 1817 - 1828
• Main Authors: Liu, Jiawei, Chaij, Jasmine, Linguraru, Marius George, French, Brooke, Keating, Robert, Alexander, Allyson L., Porras, Antonio R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2024; Springer Nature B.V
• Subjects: Birth defects; Bone density; Bone mineral density; Computed tomography; Craniosynostosis; Image processing; Image resolution; Imaging; Intracranial pressure; Medical imaging; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Paediatric Neuroradiology; Patients; Pediatrics; Radiology; Skull; Statistical methods; Thickness; Head CT image; Cranial bone anomalies; Pediatric chronic increased intracranial pressure
• ISSN: 0028-3940; 1432-1920; 1432-1920
• DOI: 10.1007/s00234-024-03393-0

Purpose
The diagnosis of chronic increased intracranial pressure (IIP)is often based on subjective evaluation or clinical metrics with low predictive value. We aimed to quantify cranial bone changes associated with pediatric IIP using CT images and to identify patients at risk.
Methods
We retrospectively quantified local cranial bone thickness and mineral density from the CT images of children with chronic IIP and compared their statistical differences to normative children without IIP adjusting for age, sex and image resolution. Subsequently, we developed a classifier to identify IIP based on these measurements. Finally, we demonstrated our methods to explore signs of IIP in patients with non-syndromic sagittal craniosynostosis (NSSC).
Results
We quantified a significant decrease of bone density in 48 patients with IIP compared to 1,018 normative subjects (
P
 < .001), but no differences in bone thickness (
P
 = .56 and
P
 = .89 for age groups 0–2 and 2–10 years, respectively). Our classifier demonstrated 83.33% (95% CI: 69.24%, 92.03%) sensitivity and 87.13% (95% CI: 84.88%, 89.10%) specificity in identifying patients with IIP. Compared to normative subjects, 242 patients with NSSC presented significantly lower cranial bone density (
P
 < .001), but no differences were found compared to patients with IIP (
P
 = .57). Of patients with NSSC, 36.78% (95% CI: 30.76%, 43.22%) presented signs of IIP.
Conclusion
Cranial bone changes associated with pediatric IIP can be quantified from CT images to support earlier diagnoses of IIP, and to study the presence of IIP secondary to cranial pathology such as non-syndromic sagittal craniosynostosis.