{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T23:03:09Z","timestamp":1792710189030,"version":"4.5.0"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Quantitative measurements of trigonocephaly can be used to characterize and track this phenotype, which is associated with metopic craniosynostosis. Traditionally, trigonocephaly metrics were extracted from CT scans; however, this method exposes patients to ionizing radiation. Three-dimensional optical scans are another option but are not routinely available in most outpatient settings. Recently, the authors developed semiautomated artificial intelligence algorithms that extract craniometric data from orthogonal 2D photographs. Although 2D photographs are safe, inexpensive, and straightforward to obtain, the accuracy of photograph-based craniometrics in comparison to CT and 3D optical scan correlates has not been established. In this study the authors compared the classification power of 2D photograph\u2013based metrics of trigonocephaly with four CT-based metrics and one 3D optical scan\u2013based metric in a heterogeneous series of patients who presented to an outpatient craniofacial clinic.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>In this study the authors performed retrospective craniometric analyses of patient 2D photographs, 3D optical scans, and CT scans. Imaging-derived craniometrics include the 2D photograph\u2013based anterior arc angle (AAA<jats:sub>2D-photo<\/jats:sub>), anterior-posterior ratio (APR<jats:sub>2D-photo<\/jats:sub>), and anterior-middle ratio (AMR<jats:sub>2D-photo<\/jats:sub>); the CT-based anterior arc angle (AAA<jats:sub>CT<\/jats:sub>), metopic index (MI<jats:sub>CT<\/jats:sub>), endocranial-bifrontal angle (eBFA<jats:sub>CT<\/jats:sub>), and interfrontal angle (IFA<jats:sub>CT<\/jats:sub>); and the 3D optical scan\u2013based anterior arc angle (AAA<jats:sub>3D-optical<\/jats:sub>). Receiver operating characteristics (ROCs) were used to identify craniometrics strongly descriptive of trigonocephaly. Interrater comparisons were made between paired trigonocephaly measurements obtained from photographs and either CT scans or 3D optical scans.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>There were 13 photograph-based and CT-based pairs and 22 paired measurements from 2D photographs and 3D optical scans. AAA displayed the strongest classification capacity across all three imaging modalities. Significant agreement was observed between AAA<jats:sub>CT<\/jats:sub> and AAA<jats:sub>2D-photo<\/jats:sub> (intraclass correlation coefficient [ICC] = 0.68 [95% CI 0.24\u20130.89], p = 0.0035), and AAA<jats:sub>3D-optical<\/jats:sub> and AAA<jats:sub>2D-photo<\/jats:sub> (ICC = 0.70 [95% CI 0.41\u20130.87], p &lt; 0.0001). There was no significant correlation between APR<jats:sub>2D-photo<\/jats:sub> or AMR<jats:sub>2D-photo<\/jats:sub> and conventional CT-based metrics describing longitudinal width ratios (MI<jats:sub>CT<\/jats:sub>).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Photograph-based craniometrics are powerful tools that can be used to quantify the severity of trigonocephaly and exhibit high concordance with standard measurements derived from CT scans and 3D optical scans. The authors developed and freely share a research-use application to calculate trigonocephaly metrics from 2D photographs. Given the availability of digital photography, lack of ionizing radiation, and low cost of photograph-based craniometric derivation, this technique may be useful to supplement routine ambulatory care and objectively track outcomes following treatment.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.2.peds22511","type":"journal-article","created":{"date-parts":[[2023,4,7]],"date-time":"2023-04-07T21:43:12Z","timestamp":1680903792000},"page":"82-90","source":"Crossref","is-referenced-by-count":5,"title":["Clinical metrics and tools for provider assessment and tracking of trigonocephaly"],"prefix":"10.3171","volume":"32","author":[{"given":"Nathan K.","family":"Leclair","sequence":"first","affiliation":[{"name":"School of Medicine, University of Connecticut Health Center, Farmington, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Chern","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Healthcare of Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward S.","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Chamis","sequence":"additional","affiliation":[{"name":"Hanger Orthotics, Hartford, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitch R.","family":"Paro","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Connecticut Health Center, Farmington, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Lambert","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, UMass Chan Medical School, Worcester, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petronella","family":"Stoltz","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Connecticut Children\u2019s Medical Center, Hartford;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Hersh","sequence":"additional","affiliation":[{"name":"Departments of Surgery and"},{"name":"Pediatrics, UConn School of Medicine, Farmington, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan E.","family":"Martin","sequence":"additional","affiliation":[{"name":"Departments of Surgery and"},{"name":"Pediatrics, UConn School of Medicine, Farmington, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus J.","family":"Bookland","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Healthcare of Atlanta, Georgia;"},{"name":"Departments of Surgery and"},{"name":"Pediatrics, UConn School of Medicine, Farmington, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Transl Pediatr","first-page":"247","article-title":"Endoscopic craniosynostosis repair","volume":"3","author":"Proctor MR","year":"2014","unstructured":"Proctor MR. 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