Making the Diagnosis in Sagittal Craniosynostosis—It’s Height, Not Length, That Matters

Jessica D. Blum, Daniel Y. Cho, Liana Cheung, Dillan F. Villavisanis, Jinggang Ng, Jordan W. Swanson, Scott P. Bartlett, Jesse A. Taylor

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Introduction: This study assesses the diagnostic reliability of a novel photogrammetric measurement to distinguish sagittal craniosynostosis (SS) from control and false positive cases (SNS). Methods: Head CTs from 2014–2020 were reviewed for patients with sagittal synostosis (SS, n = 177), presumed sagittal synostosis with normal imaging (SNS, n = 30), and controls (n = 100). Using preoperative clinical photographs and CTs, a measurement reflecting the anterior–posterior location of the vertex was measured using an angle drawn between the cranial vertex, nasion, and opisthocranion (VNO) in profile view, with the head in a neutral position. Results: Mean age at pre-operative head CT was 9.5 months for the SS cohort, 4.2 months for the SNS cohort, and 8.9 months for controls (p =.327). Mean age at pre-operative clinical photograph was 9.5 months for the SS cohort and 4.2 months for the SNS cohort (p =.149). Pearson correlations revealed no significant association between age and VNO angle. The average VNO angle measured on clinical photographs was 54.7° ± 3.8° for the SS group, 43.1° ± 2.2° for the SNS group, and 41.1° ± 3.7° for controls (p <.001). Receiver operating characteristic (ROC) analysis yielded a cut-off of ≥ 50° to identify SS. Diagnostic sensitivity and specificity were 96.6% and 99.2%, respectively. Three-rater analysis yielded an average ICC of 0.742 (p =.004). Conclusions: Measurement of the VNO angle is a reliable screening tool to diagnose sagittal craniosynostosis, with an angle of 50° or more suggesting suture synostosis. This method relies on the relationship between the anterior displacement of the vertex and occipital bulleting to approach the diagnostic accuracy of CT imaging.

Original languageEnglish
Pages (from-to)1331-1340
Number of pages10
JournalChild's Nervous System
Issue number7
StatePublished - Jul 2022
Externally publishedYes


  • Craniosynostosis
  • Diagnosis
  • Diagnostics
  • Sagittal Craniosynostosis


Dive into the research topics of 'Making the Diagnosis in Sagittal Craniosynostosis—It’s Height, Not Length, That Matters'. Together they form a unique fingerprint.

Cite this