Assessment of Follow-Up Sonography and Clinical Improvement among Infants with Congenital Muscular Torticollis

H.-J. Park; S.S. Kim; S.-Y. Lee; Y.-T. Lee; K. Yoon; E.-C. Chung; M.-H. Rho; H.-J. Kwag

doi:10.3174/ajnr.A3299

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Fig. 1.
One-month-old boy with congenital muscular torticollis on the right side. A, Transverse gray-scale sonogram of the lower one-third of the right side of the neck shows the hypertrophied SCM (diameter, 1.08 cm). B, The intact left muscle measured 0.40 cm, and the SCM thickness ratio was 2.70. The initial modified Cheng score was 0. C, Follow-up sonography of the involved muscle shows a decreased thickness of 0.71 cm 6 months later. D, At follow-up, the thickness of the uninvolved muscle was 0.56 cm, the SCM thickness ratio was 1.27, and the modified Cheng score was 6.
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Fig. 2.
Two-month-old boy with congenital muscular torticollis on the left side. A, Transverse sonogram of the left side of the neck shows the hypertrophied SCM (diameter, 0.57 cm). B, The intact right muscle measured 0.38 cm, and the SCM thickness ratio was 1.50. The initial modified Cheng score was 3. C, Follow-up sonography of the involved muscle shows an increased thickness of 0.68 cm 3 months after the initial evaluation. D, At follow-up, the thickness of the uninvolved muscle was 0.54 cm, the SCM thickness ratio was 1.26, and the modified Cheng score was 6.
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Fig. 3.
Five-day-old boy with congenital muscular torticollis on the right side. A, Transverse sonogram of both sides of the neck shows the hypertrophied muscle (diameter, 0.46 cm) on the right side and the normal muscle on the left side (diameter, 0.43 cm). The initial thickness ratio was 1.07, and the initial modified Cheng score was 0. B, Follow-up sonography of the involved muscle shows an increased thickness of 1.03 cm 2 months after the initial evaluation. C, At follow-up, the thickness of the uninvolved muscle was 0.46 cm, the SCM thickness ratio was 2.24, and the modified Cheng score was 1.

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Table 1:

The mean values of sternocleidomastoid muscle thickness, the SCM thickness ratio, and the modified Cheng scores^{^a}

	Thickness of Involved Muscle (cm)		Thickness of Normal Muscle (cm)		SCM Thickness Ratio^{^b}		Modified Cheng Score
	Reader 1	Reader 2	Reader 1	Reader 2	Reader 1	Reader 2	Modified Cheng Score
Initial	0.86 (±0.35)	0.84 (±0.36)	0.49 (±0.08)	0.52 (±0.08)	1.77 (±0.70)	1.65 (±0.72)	3.38 (±2.46)
Follow-up	0.75 (±0.27)	0.74 (±0.26)	0.57 (±0.09)	0.58 (±0.09)	1.34 (±0.50)	1.29 (±0.48)	4.90 (±1.59)

↵a Data in parentheses are SDs.
↵b Ratio is the thickness of involved muscle/thickness of normal muscle.

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Table 2:
The intraclass correlation coefficients for the SCM thickness measurements and the SCM thickness ratio
Thickness of Involved Muscle Thickness of Normal Muscle SCM Thickness Ratio P Value
Initial 0.952 0.919 0.950 <.001
Follow-up 0.988 0.935 0.976 <.001
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Table 3:
Correlation coefficients indicating the relationship between study variables and clinical prognosis^{^a}
P1^{^b} ΔP^{^c} R1^{^d} ΔR^{^e}
Reader 1 0.434 (.002) 0.384 (.007) 0.481 (.001) 0.394 (.006)
Reader 2 0.488 (<.001) 0.380 (.008) 0.509 (<.001) 0.366 (.011)
↵a Numbers in parentheses are P values. P values <.01 were considered statistically significant.
↵b P1 is the initial maximal thickness of the sternocleidomastoid muscle.
↵c ΔP is the difference in the maximal thickness of the SCM between initial and follow-up measurements.
↵d R1 is the initial SCM thickness ratio (maximal thickness of the involved muscle/maximal thickness of the normal muscle).
↵e ΔR is the difference in the SCM thickness ratio between initial and follow-up measurements.