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The Infant Skull: A Vault of Information¹

¹ From the Department of Radiology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029 (R.B.J.G., K.I.N., P.S.C., T.P.N.); and the Department of Radiology, Evanston Hospital and Northwestern University, Evanston, Ill (S.K.F.). Recipient of a Certificate of Merit award for an education exhibit at the 2002 RSNA scientific assembly. Received April 14, 2003; revision requested June 3 and received July 18; accepted July 21. All authors have no financial relationships to disclose. Address correspondence to R.B.J.G. (e-mail: ronald.glass@mountsinai.org).

The art of interpreting skull radiographs is slowly being lost as trainees in radiology see fewer plain radiographs and depend more heavily on computed tomography and magnetic resonance imaging. Nevertheless, skull radiographs still provide significant information that is helpful in finding pathologic conditions and appreciating their extents. Abnormalities in the skull may be reflected as variations in the density, size, and shape of the skull, as well as skull defects. Skeletal dysplasias may manifest as a generalized decrease in calvarial density (hypophosphatasia, osteogenesis imperfecta), a generalized increase in calvarial density (osteopetrosis), or a focal increase in density (frontometaphyseal dysplasia). Diffusely decreased or increased calvarial density is usually associated with a process that affects the entire skeleton. Therefore, correct differentiation among these dysplasias depends on other concurrent features. Decreased size of the cranial vault at birth generally implies an underlying insult to the brain, including fetal alcohol syndrome and the so-called TORCH infections (toxoplasmosis, rubella, cytomegalovirus infection, herpes simplex). Macrocephaly may result from skeletal dysplasia or an increase in the intracranial volume (eg, due to underlying anomalies of the brain such as hydrocephalus).

© RSNA, 2004

Index Terms: Infants, skeletal system, 10.10, 11.10 • Skull, abnormalities, 10.10, 10.143, 10.144 • Skull, diseases, 10.15, 10.1521, 10.1552, 10.1553, 10.16, 10.172, 10.593, 10.873 • Skull, injuries, 10.40 • Skull, radiography, 10.10, 11.10 • Skull, secondary neoplasms, 10.33

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