Purpose or Case Report: Computed tomography (CT) is the standard for skull evaluation, but radiation exposure is a major concern in pediatric patients. This study investigated whether incorporating Zero Echo Time (ZTE) sequence into routine pediatric brain MRI could provide additional diagnostic information of skull regarding craniosynostosis and skull fractures without the need for CT.
Methods & Materials: We retrospectively reviewed 12 pediatric patients (8 boys and 4 girls; age range, 6 months–7 years) who underwent brain MRI including ZTE between March and October 2025. Indications included suspected craniosynostosis (n=9) and skull fracture (n=3). The average acquisition time for ZTE was ranging from 4 minutes 25 seconds to 5 minutes 50 seconds. Images and radiology reports were analyzed to evaluate diagnostic utility for suture fusion, fracture lines, and additional calvarial findings.
Results: ZTE successfully delineated cranial sutures in all nine patients with craniosynostosis, allowing confident diagnosis of sagittal, coronal, and lambdoid synostoses, including partial and multiple suture involvements. In three patients with suspected skull fracture, ZTE clearly demonstrated fracture lines and obviated the need for CT confirmation. One case demonstrated calcified cephalhematoma that was readily visualized on ZTE. Image quality was consistently diagnostic, and scan times were compatible with routine pediatric MRI protocols without significant prolongation of total exam time.
Conclusions: The addition of ZTE sequence to pediatric brain MRI provides robust diagnostic information for craniosynostosis and skull fractures. Given its actual acquisition time and diagnostic quality, ZTE can replace CT without increasing the need for additional sedation, thereby offering clear additive value as a radiation-free alternative for skull assessment in children.