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American Association of Plastic Surgeons

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Comparison Of 3d Reconstructed Golden Angle Stack Of Stars Radial Mr Images With Ct In Children
kamlesh Patel, MD, MSc, Cihat Eldeniz, BS, Paul Commean, BS, Gary Skolnick, BS, Uday Jammalamadaka, BS, Manu Goyal, MD, Matthew Smyth, MD, Hongyu An, PhD.
Washington University St. Louis, Saint Louis, MO, USA.

PURPOSE:
To avoid radiation exposure, we aim to replace CT with MRI for diagnosis, pre-operative planning and cranial suture visualization. In this study, we use a high-resolution 3D golden-angle (GA) stack-of-stars radial MR sequence that is intrinsically robust to motion and has enhanced bone vs. soft-tissue contrast. METHODS:
Patients under 11 years old were eligible for the study. 3D reconstructions created from a 5-minute MRI sequence and the gold standard CT were randomized and presented to three blinded reviewers for assessment. For each image set, each reviewer noted on five-point Likert scales whether they recommended that a second scan be performed. The presence or absence of the six primary cranial sutures was recorded. RESULTS:
Eleven patients (median age 2 years) underwent an MRI after a clinical head CT was performed. Five of the 11 patients were sedated. A clinician reported the “need for another scan to make my diagnosis” in 0/33 readings from CT and 4/33 readings (12%) from MRI. With CT as the standard, sensitivity and specificity of the GA MRI sequence to detect suture patency was 94% and 92%, respectively (n = 195 sutures read). Intra-rater reliability was excellent (intraclass correlation coefficient (ICC) = 0.989), and reviewer agreement high (ICC = 0.687). CONCLUSION:
The 3D reconstructed images using the GA sequence in comparison to CT created clinically acceptable cranial images with excellent ability to detect suture patency. Future directions include reducing the scan time, and automating motion correction and post processing for clinical utility.


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