Diagnosis of Impaired Brain Perfusion in Children with Craniosynostosis by Magnetic Resonance Imaging

BACKGROUND: Craniosynostosis is a medical condition characterized by the premature fusion or absence of cranial sutures, leading to an abnormal head shape and a potential risk of neurological disorders. There is a growing interest in the early diagnosis of craniosynostosis. Delayed treatment of synostoses can impede normal cranial bone growth, resulting in cranial deformities, craniocerebral disproportion, and microcephaly. The abnormal head shape may result in the compression of brain tissue, meninges, and vascular structures in the affected regions. Noninvasive imaging techniques are currently available for assessing cerebral hemodynamics. Dynamic susceptibility contrast magnetic resonance perfusion facilitates the evaluation of relative cerebral blood flow in regions suspected of brain compression in pediatric patients with craniosynostoses.

AIM: To evaluate cerebral blood flow in children with craniosynostoses using dynamic susceptibility contrast magnetic resonance perfusion to determine relative hemodynamic parameters, such as cerebral blood flow and cerebral blood volume.

METHODS: The study included a total of 52 children diagnosed with different types of craniosynostosis. The age of the participants ranged from 3 to 38 months. They were assessed using a 1.5T magnetic resonance imaging scanner with an intravenous paramagnetic contrast agent (0.1 mmol/kg of body weight) administered during drug-induced sleep. The standard brain examination protocol was augmented with dynamic susceptibility contrast magnetic resonance perfusion pulse sequences.

RESULTS: A comprehensive analysis of the findings demonstrated that metopic, mono- and bicoronal synostosis were associated with reduced cerebral blood flow and blood volume in the compressed region when compared with the contralateral intact region. In contrast, no significant differences in magnetic resonance perfusion findings were identified between the affected and intact regions for the patients with sagittal craniosynostosis.

CONCLUSION: This study found that dynamic susceptibility contrast magnetic resonance perfusion can be a useful tool for assessing changes in cerebral perfusion. This finding offers novel prospects for planning treatment strategies. The proposed approach has the potential to serve as a valuable tool for patient assessments during both the early and late postoperative periods.