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Boogard’s angle have the best diagnostic accuracy for basilar invagination.
Chamberlain line and Boogard’s angle have an excellent inter-rater agreement.
In cases where odontoid apex to the Chamberlain line distance cannot be measured, the best alternative is Boogard's angle.
This study aims to determine the reliability of the radiological tests used in the diagnosis of basilar invagination (BI).
Patients diagnosed with type B basilar invagination, who had both magnetic resonance (MR) and computed tomography (CT) imaging between January 2014 and November 2019 were included in this retrospective reliability study. In this study, distance from odontoid apex to Chamberlain’s line (OA-CL) was accepted as a reference method for the diagnosis. Forty-two BI cases and 79 controls were included. Three radiologists with different levels of experience individually evaluated OA-CL, Boogard’s angle (BoA), clivo-axial angle (CXA), clivo-dens angle (CDA), and clivo-palate angle (CPA) on midsagittal CT and MR images. Statistical analysis was made with the intraclass correlation coefficient (ICC), t-test, and receiver operating characteristic (ROC) curve.
The ICC for CT and MR were; 0.977−0.973 (OA-CL), 0.912−0.882 (BoA), 0.845−0.846 (CXA), 0.862−0.864 (CDA), and 0.762−0.747 (CPA) respectively (P < 0.001). The areas under the ROC curve were 0.977 (BoA), 0.832 (CXA), 0.852 (CDA), and 0.719 (CPA) (P < 0.001). The cut-off measures were ≥137.84° (BoA), ≤149.25° (CXA), ≤129.58° (CDA), and ≤61.83° (CPA). The diagnostic accuracies were 0.954 (BoA), 0.664 (CXA), 0.704 (CDA), 0.438 (CPA) (P < 0.001).
OA-CL and BoA express excellent inter-rater agreement than CXA, CDA, and CPA, which are limited due to morphological variations and head spatial position. BoA is the second most reliable diagnostic test. CXA, CDA, should only be used for complementary information. CPA was found inadequate for the diagnosis of BI.Le texte complet de cet article est disponible en PDF.
Keywords : Skull base, Atlanto-occipital joint, Odontoid process, Magnetic resonance imaging, Multidetector computed tomography
|☆|| This study was presented in Turkish Society of Neuroradiology 29th Year Annual Meeting with International Participation Neuroradiology and Head Neck Radiology, February 14–16, 2020, Istanbul, Turkey
|☆☆|| Abstract of the manuscript was published Neuroradiology journal in February 2020 entitled TSNR 2020 page 263–266.