New diagnostic modalities support assessment of deformational plagiocephaly in children

1. This systematic review of 22 studies suggests that standardized head shape measurements and photography techniques demonstrate high reliability and similar diagnostic utility to gold standard modalities in the evaluation of deformational plagiocephaly.

2. Improvements in automated diagnostic algorithms and smartphone-based imaging techniques offer a promising avenue for rapid, objective, and accurate office-based assessment of childhood plagiocephaly.

Level of evidence assessment: 2 (good)

Summary of the study: Plagiocephaly deformans is a common condition in infants that can cause adverse cosmetic and developmental outcomes. On an outpatient basis, the evaluation consists of a physical examination and measurement of the head circumference, which can be non-specific and present a challenge in assessing the need for referral to physiotherapy or neurosurgery. This systematic review assessed the past three decades of advances in diagnostic modalities for assessing cranial deformities in infants. Five methods of objective analysis of cranial asymmetry were identified in 22 studies: 1) anthropometry, standardized measurement of the skull with calipers, 2) plagiocephalometry (PCM), the use of a thermoplastic tape that hugs the infant’s head allowing for anthropomorphic measurements, 3) single-image digital photography of the infant’s skull from a top-down perspective, 4) 3D photogrammetry using a set of still images from a single smartphone or configuration staged multicamera, and 5) laser scanning to create a 3D model of the infant direct. Although they often used different indices to estimate cranial asymmetry, these studies demonstrated high inter- and intra-rater reliability and had diagnostic utility comparable to baseline CT imaging and/or expert assessments. . Comparison of modalities was not possible due to heterogeneity of measurements, validation methods, and reference standards across studies. The high reliability and robustness of individual diagnostic validation studies, however, support the review’s assertion that accessible quantitative methods of monitoring deformational plagiocephaly are already available to ambulatory paediatricians.

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Relevant reading: A role for artificial intelligence in the classification of craniofacial anomalies.

In depth [systematic review]: This systematic review included 22 articles published between 2005 and 2021 that investigated the use of non-radiographic and novel modalities to diagnose plagiocephaly in young children. 19/22 of the studies were found to be at low risk of bias using the study quality assessment of diagnostic accuracy. If available, data on accuracy, time to diagnosis, reliability, and outcome were extracted from each study by two independent reviewers. Five unique modalities – anthropometry, plagiocephalometry, digital photography, 3D photogrammetry and 3D laser scanning – have been identified. Key themes that emerged from the review included the method of head shape analysis, the integration of smartphone technology into ambulatory digital imaging techniques, and rapid advances in machine learning and automated diagnosis in improving the evaluation of deformational plagiocephaly.

Picture: PD

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