Cone beam CT for the assessment of bone microstructure to predict head shape changes after spring-assisted craniosynostosis surgery

Head shape changes following spring-cranioplasty for craniosynostosis (CS) can be difficult to predict. While previous research has indicated a connection between surgical outcomes and calvarial bone microstructure ex-vivo, there exists a demand for identifying imaging biomarkers that can be translated into clinical settings and assist in predicting these outcomes. In this study, ten parietal (8 males, age 157 ± 26 days) and two occipital samples (males, age 1066 and 1162 days) were collected from CS patients who underwent spring cranioplasty procedures. Samples’ microstructure were examined using clinical imaging modalities (dental CBCT, C-arm CT) and micro-CT. Cranial index (CI) was measured to evaluate patients' head shape before and after surgery, with an investigation into their relationship with morphometric measurements. Bone cross-sectional thickness (CsTh) showed significant correlation to CI increase post-SAC for C-arm CT (ρ = −0.857, p = 0.014) and 8.9 μm micro-CT (ρ = −0.857, p = 0.014). In addition, bone volume (BV) was correlated to CI increase for CBCT (ρ = −0.643, p = 0.013), 50 μm micro-CT (ρ = −0.857, p < 0.001) and 90 μm micro-CT (ρ = −0.679, p = 0.008). High correlation with micro-CT resampled to match respective voxel sizes was demonstrated for both CBCT and C-arm CT measurements of CsTh and BV (ρ ≥ 0.860, p < 0.001). This preliminary study demonstrates the potential of clinical CT devices to aid in pre-surgical decision making in CS.