Cranial Ratio Research Articles

Two-Dimensional Image-Based Screening Tool for Infants with Positional Cranial Deformities: A Machine Learning Approach.

Positional cranial deformities are relatively common conditions, characterized by asymmetry and changes in skull shape. Although three-dimensional (3D) scanning is the gold standard for diagnosing such deformities, it requires expensive laser scanners and skilled maneuvering. We therefore developed an inexpensive, fast, and convenient screening method to classify cranial deformities in infants, based on single two-dimensional vertex cranial images. In total, 174 measurements from 80 subjects were recorded. Our screening software performs image processing and machine learning-based estimation related to the deformity indices of the cranial ratio (CR) and cranial vault asymmetry index (CVAI) to determine the severity levels of brachycephaly and plagiocephaly. For performance evaluations, the estimated CR and CVAI values were compared to the reference data obtained using a 3D cranial scanner. The CR and CVAI correlation coefficients obtained via support vector regression were 0.85 and 0.89, respectively. When the trained model was evaluated using the unseen test data for the three CR and three CVAI classes, an 86.7% classification accuracy of the proposed method was obtained for both brachycephaly and plagiocephaly. The results showed that our method for screening cranial deformities in infants could aid clinical evaluations and parental monitoring of the progression of deformities at home.

Treatment Efficacy of Deformational Plagiocephaly and Brachiocephaly

INTRODUCTION: Although various treatments for deformational plagiocephaly (DP) and brachiocephaly (DB) have been well described, previous studies evaluating their efficacy are limited by small cohorts, inadequate follow-up, lack of reliable objective outcomes measures, and influence of commercial interests.1–3 This study analyzed the efficacy of repositioning, physical therapy (PT) and cranial molding in the treatment of DP/DB in a large, prospective cohort utilizing objective outcome measures. METHODS: All patients undergoing treatment of DP/DB between 2004 and 2010 were followed until cure or 18 months of age. Patients underwent either regimented conservative treatment (repositioning and/or PT) and/or cranial orthotic molding. Outcomes where measured objectively using a 3D laser surface scanner. Complete correction was defined as a cranial ratio (CR)<0.85 and diagonal difference (DD)<5mm. Independent risk factors for treatment failure were identified for each group by multivariate analysis. RESULTS: The study included 4,378 patients with DP/DB. Conservative treatment (repositioning and/or PT) was initiated in 3,381 infants, and cranial orthotic molding in 997 infants. Of patients initially treated conservatively, 22.9% failed management (15.8% required cranial molding, 7.1% had incomplete correction). Independent risk factors for conservative treatment failure included DP/DB severity (RR 1.31-1.64), advanced age (RR 1.20-2.08), torticollis (RR 1.12-1.74), developmental delay (RR 1.44) and poor treatment compliance (RR 2.4). Prematurity and male gender were non-risk factors; multiparity and vaginal delivery were protective. Ultimately, 1,531 patients underwent cranial orthotic molding (997 initially assigned, 534 failed conservative management), and 95.0% achieved complete correction. Independent risk factors for cranial orthotic molding failure included advanced age (RR 1.13-3.08) and poor treatment compliance (RR 3.01). CONCLUSION: Repositioning, PT, and cranial orthotic molding are effective treatments for DP/DB. Appropriate selection of a treatment modality requires evaluation of patient-specific risk factors. Cranial orthotic molding appears to isolate out intrinsic and environmental factors that increase the risk of conservative treatment failure.