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Over the Ridge: Discerning Metopic Ridge vs. Metopic Craniosynostosis Using an Image-Based, Deep-Phenotyping Toolset
Cristian Gonzalez, Joseph Mocharnuk, Anne Glenney, Nicole H. Goldschmidt, Angel Dixon, Nicolas M. Kass, Alexander Comerci, Carlos E. Barrero, Lauren Salinero, Wenzheng Tao, Erin Anstadt, Lucas A. Dvoracek, Megan Pencek, Ross Whitaker, Lisa R. David, Jesse Goldstein
UPMC Children's Hospital of Pittsburgh
2024-01-15
Presenter: Cristian Gonzalez
Affidavit:
Yes
Director Name: Jesse Goldstein
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: This study highlights the challenge in distinguishing metopic craniosynostosis, emphasizing the need for standardization. We compare CranioRate's tool to subjective measurements with surgeons' visual assessments to demonstrate its utility in objectively evaluating metopic ridge (MR) vs. metopic craniosynostosis (MC).
Methods: A mixed qualitative/quantitative survey comprised of demographic questions and 20 anonymized, randomized-order CT scan clinical vignettes (10 each of MR and MC) was distributed to the professional Listserv of the American Society of Craniofacial Surgery over six months beginning in March 2023. Respondent information (e.g., age, gender, training background) was collected. Using descriptive statistics, univariate analysis, and regression analysis, data was analyzed in R Studio (V 1.3.1093).
Results: 27 complete responses were received. On average, the correct identification rate of clinical vignettes was 66.8% (SD: 28%). There was a significantly higher correct identification rate of MR CT scans than of MC CT scans (p-value =.02). Additionally, there was a statistically significant association between metopic severity score (MSS), one of CranioRate's two standardized measures for phenotypic severity, and the correct identification of an image as either MR or MC (p-value = 0.03). Among the MC scans only, decreasing MSS (i.e., milder phenotypes) were associated with a significant increase in image identification error by craniofacial surgeons (p-value = 0.023).
Conclusions: Our study reveals variable accuracy among craniofacial surgeons in visually distinguishing MR and MC, especially in mild cases. It underscores the clinical need for an objective measurement tool to aid accurate classification, potentially preventing unnecessary surgery for patients with MR.
