MRI for Positional Plagiocephaly Diagnosis
MRI plays no role in diagnosing positional plagiocephaly and should not be used for this purpose. 1, 2
Clinical Examination is Sufficient
- Clinical examination alone is sufficient to diagnose positional plagiocephaly in the vast majority of cases, eliminating the need for any imaging including MRI. 1, 3
- The Congress of Neurological Surgeons systematic review found that imaging is rarely necessary and should be reserved exclusively for cases where clinical examination is equivocal. 1
- In their review of 32 studies, clinical examination correctly diagnosed positional plagiocephaly in 258 of 261 cases without any imaging. 4
When Imaging is Needed (Not MRI)
If clinical examination cannot definitively exclude craniosynostosis, the appropriate imaging hierarchy is:
- First-line imaging: Skull X-rays or ultrasound of the suspect suture - these are almost always sufficient for definitive diagnosis when clinical examination is equivocal. 1, 2
- Ultrasound can effectively assess suture patency in infants and avoids radiation exposure entirely. 2, 4
- 3D topographical scanning may be useful for baseline severity assessment but is not required for diagnosis. 1, 2
- CT scanning should be used sparingly and only when absolutely necessary to rule out true craniosynostosis, as it carries significant radiation risks. 1, 2
MRI's Limited Role
MRI is only indicated when evaluating for associated intracranial complications such as Chiari malformation in confirmed craniosynostosis cases, not for diagnosing plagiocephaly itself. 3
Critical Pitfall to Avoid
Do not order MRI (or routine CT) for suspected positional plagiocephaly. 1, 2 This exposes infants to unnecessary sedation risks (required for MRI in infants), healthcare costs, and provides no diagnostic benefit over clinical examination or simpler imaging modalities like ultrasound when truly needed. 2