Brain volume and shape in infants with deformational plagiocephaly

Purpose: Infants with deformational plagiocephaly (DP) have been shown to exhibit developmental delays relative to unaffected infants. Although the mechanisms accounting for these delays are unknown, one hypothesis focuses on underlying differences in brain development. In this study, we used MRI to examine brain volume and shape in infants with and without DP. Methods: Participants included 20 infants with DP (mean age= 7.9 months, SD=1.2; n=12 male) and 21 controls (mean age= 7.9 months, SD=1.3; n=11 male). Measures included volumes of the total brain and cerebellum; midsagittal areas of the corpus callosum and cerebellar vermis; and linear distance measures used to quantify the shape of selected brain structures. We also evaluated the association between shape measures and developmental scores on the Bayley Scales of Infant and Toddler Development-III (BSID-III). Results: Brain volume did not distinguish cases and controls (p=.214-.976). However, cases exhibited greater asymmetry and flattening of the posterior brain (p<.001-.002) and cerebellar vermis (p=.035), shortening of the corpus callosum (p=.012), and differences in the orientation of the corpus callosum (p=.005). Asymmetry and flattening of brain structures were associated with worse developmental outcomes on the BSID-III. Conclusions: Infants with DP show differences in brain shape, consistent with the skull deformity characteristic of this condition, and shape measures were associated with infant development. Longitudinal studies, beginning in the neonatal period, are needed to clarify whether developmental effects precede or follow brain deformation.