Computed and magnetic resonance imaging to identify structural and perfusion changes in the brain in children with craniosynostosis

Purpose. To compare the degree of skull bone deformation and brain perfusion parameters using computerized tomography and magnetic resonance imaging (MRI) in children with craniosynostosis before surgery.

Materials and methods. In the period from 2018 to 2024, we examined 51 children at the Almazov National Research Medical Center with various types of craniosynostosis. We used CT scans to assess the cranial sutures and degree of skull deformation by morphometric measurements, and MRI to evaluate the structural and perfusion parameters of the brain, supplemented by dynamic contrast-enhanced T2* MR perfusion. Statistical analysis was performed using the R programming language version 4.4.1.

Results. The study revealed characteristic morphometric and perfusion disorders in various types of craniosynostosis. The largest increase in the cephalic index was found in brachycephaly (118.0 ± 4.6%), and the smallest in sagittal synostosis (67.4 ± 10.4%). Significant cranial asymmetry was observed in patients with posterior plagiocephaly (12.4 ± 1.1%) and coronal synostosis (5.8 ± 4.8%). A decrease in the frontal angle was characteristic of trigonocphaly (91.6 ± 9.9), anterior plagiocephaly (93.2 ± 7.0) and sagittal synchosis (87.4 ± 9.1). In all groups, there was a decrease in cerebral blood flow velocity (rCBF: 66.8–82.1%), cerebral blood volume (rCBV:57.3–88.7), an increase in mean transit time (MTT:108–120.5) and time to peak (TTP:103.7–121.1). The most pronounced perfusion abnormalities were recorded in brachiocephalic and triangulocephalic.

Conclusion. Dynamic contrast MR perfusion can be a promising technique for assessing cerebral circulation in children with craniosynostosis. The use of this technique allows evaluating the main parameters of perfusion in the most compressed areas of the brain. The data obtained demonstrate the systemic effect of craniostenosis on cerebral hemodynamics, in the absence of a direct correlation between the degree of morphological and perfusion changes, this emphasizes the role of individual compensatory mechanisms. Further research on this technique could expand the diagnostic criteria for surgical treatment and serve as a tool for evaluating its effectiveness in postoperative stages. Dynamic contrast MR perfusion can become a tool for evaluating the effectiveness of surgical interventions performed in the early and late postoperative stages.

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