Imaging description

Skull radiographs may still be performed to evaluate for pediatric calvarial fractures. However, at most facilities, radiography has been replaced by CT due to its superior detection and characterization of fractures and sutures, and assessment of intracranial pathology. Even on CT, calvarial fractures may be difficult to identify because of the thin cortex in children. Three-dimensional shaded surface reconstructions of the skull (3D-CT) are invaluable to evaluate for pediatric head trauma [1–3]. This technique offers exquisite detail in characterizing surface anatomy and the osseous defect(s) in question. MRI provides no significant advantage over CT to distinguish fractures from normal sutures.

Common sutures include the midline sagittal and metopic, and bilateral coronal and lambdoid. Accessory sutures are most common in the parietal and occipital bones. The parietal bone arises from two ossification centers, while the occipital bone ossifies from six centers [1, 2, 4, 5].