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Surg Radiol Anat (2010) 32:807816 DOI 10.1007/s00276-010-0633-5
REVIEW
Occipital sutures and its variations: the value of 3D-CT and how to differentiate it from fractures using 3D-CT?
Arabinda Kumar Choudhary Bhawna Jha
Danielle K. Boal Mark Dias
Received: 22 September 2009 / Accepted: 30 January 2010 / Published online: 23 February 2010 Springer-Verlag 2010
Abstract The anatomy and embryology of occipital bone are complex and may present with a varied ossication pattern and masquerade as fractures. There are only a few articles in the literature and none on CT appearance of occiput ossication and sutures. Awareness of the normal and variant anatomy, appearance and position along with age of fusion of sutures will be helpful in condently differentiating variant suture from fracture. This will be particularly important in children in the eld of non-accidental injury with its attendant medicolegal complications. We describe the normal anatomy, embryology, normal and variant sutures of occipital bone as published in the literature so far and present a pictorial review of 15 cases of variant sutures. With CT as the primary modality in assessing for head injury now, it is important to know the CT features of these sutures, their appearance, position and variants and be able to utilize 3D-CT to be able to give a more denitive diagnosis.
Keywords Occipital sutures Fractures
Normal variants 3D-CT Children
Introduction
Management of skull fracture is a complex issue in children. Varied ossication pattern and sutures may mimic fractures. There are only a few articles in the literature based on the radiographic ndings of occiput ossication and sutures and none on CT appearance to the best of our knowledge. In this article, we review the anatomy and embryology of ossication of the occiput and present a pictorial review of the common variant sutures with emphasis on the CT ndings. We also discuss how the 3D-CT (three-dimensional-CT) is useful in helping to differentiate sutures and variants from fractures.
Materials and methods
Children less than 17 years old who had CT head performed were analyzed on the axial sequences in the bony window for the presence of sutures as well as variance. There is one case of an adult patient who was included to demonstrate the persistence of occipital sutures in adulthood. The axial raw...