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Clivodens Angle: A New Diagnostic Method for Basilar Invagination at Computed Tomography.
Spine (Phila Pa 1976). 2016 Sep; 41(17):1365-71.S

Abstract

STUDY DESIGN

Retrospective study.

OBJECTIVE

To investigate whether clivodens angle (CDA) could diagnose basilar invagination (BI) at computed tomography (CT).

SUMMARY OF BACKGROUND DATA

Over the years, multiple craniometric methods such as Chamberlain line, McGregor line, McRae line, Wackenheim clivus baseline, and Welcher basal angle have been described for evaluation of craniovertebral junction anomalies, initially with radiography and later with CT. However, such a variety of measurements in turn reflects the difficulty in making a definite diagnosis of BI and there is a certain disadvantage in all of these criteria because the anatomic landmarks vary within a normal range.

METHODS

CDA, described an angle formed at the intersetion of a line that runs along the long axis of the clivus and one that runs along the long axis of the dens, was measured on mid-sagittal reconstructed CT images from 63 BI patients and 100 control participants to compare the two groups by using independent-sample t test. Interobserver reliability was evaluated with Kendall correlation coefficient. For evaluating the diagnostic performance and determining the cutoff value of CDA, receiver operating characteristic curve was utilized.

RESULTS

The measurement of CDA showed good interobserver agreement (KCC = 0.891). Compared with control participants whose mean value was 135.8 degrees ± 9.2 (range, 118-156°), BI patients had a significantly smaller one (P < 0.001), 110.4 degrees ± 15.8 (range, 55-140°). The area under receiver operating characteristic curve was 0.937 (95% confidence interval: 0.901, 0.973), and the cutoff value of 125 degrees had the largest Youden index (J), 0.715.

CONCLUSION

Having a better diagnostic performance than clivoaxial angle, CDA can be utilized for diagnosing BI.

LEVEL OF EVIDENCE

3.

Authors+Show Affiliations

Shandong Medical Imaging Research Institute, Shandong University, Jinan, China.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26909827

Citation

Xu, Shuaishuai, and Ruozhen Gong. "Clivodens Angle: a New Diagnostic Method for Basilar Invagination at Computed Tomography." Spine, vol. 41, no. 17, 2016, pp. 1365-71.
Xu S, Gong R. Clivodens Angle: A New Diagnostic Method for Basilar Invagination at Computed Tomography. Spine. 2016;41(17):1365-71.
Xu, S., & Gong, R. (2016). Clivodens Angle: A New Diagnostic Method for Basilar Invagination at Computed Tomography. Spine, 41(17), 1365-71. https://doi.org/10.1097/BRS.0000000000001509
Xu S, Gong R. Clivodens Angle: a New Diagnostic Method for Basilar Invagination at Computed Tomography. Spine. 2016;41(17):1365-71. PubMed PMID: 26909827.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clivodens Angle: A New Diagnostic Method for Basilar Invagination at Computed Tomography. AU - Xu,Shuaishuai, AU - Gong,Ruozhen, PY - 2016/2/25/entrez PY - 2016/2/26/pubmed PY - 2017/6/9/medline SP - 1365 EP - 71 JF - Spine JO - Spine VL - 41 IS - 17 N2 - STUDY DESIGN: Retrospective study. OBJECTIVE: To investigate whether clivodens angle (CDA) could diagnose basilar invagination (BI) at computed tomography (CT). SUMMARY OF BACKGROUND DATA: Over the years, multiple craniometric methods such as Chamberlain line, McGregor line, McRae line, Wackenheim clivus baseline, and Welcher basal angle have been described for evaluation of craniovertebral junction anomalies, initially with radiography and later with CT. However, such a variety of measurements in turn reflects the difficulty in making a definite diagnosis of BI and there is a certain disadvantage in all of these criteria because the anatomic landmarks vary within a normal range. METHODS: CDA, described an angle formed at the intersetion of a line that runs along the long axis of the clivus and one that runs along the long axis of the dens, was measured on mid-sagittal reconstructed CT images from 63 BI patients and 100 control participants to compare the two groups by using independent-sample t test. Interobserver reliability was evaluated with Kendall correlation coefficient. For evaluating the diagnostic performance and determining the cutoff value of CDA, receiver operating characteristic curve was utilized. RESULTS: The measurement of CDA showed good interobserver agreement (KCC = 0.891). Compared with control participants whose mean value was 135.8 degrees ± 9.2 (range, 118-156°), BI patients had a significantly smaller one (P < 0.001), 110.4 degrees ± 15.8 (range, 55-140°). The area under receiver operating characteristic curve was 0.937 (95% confidence interval: 0.901, 0.973), and the cutoff value of 125 degrees had the largest Youden index (J), 0.715. CONCLUSION: Having a better diagnostic performance than clivoaxial angle, CDA can be utilized for diagnosing BI. LEVEL OF EVIDENCE: 3. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/26909827/Clivodens_Angle:_A_New_Diagnostic_Method_for_Basilar_Invagination_at_Computed_Tomography_ L2 - http://dx.doi.org/10.1097/BRS.0000000000001509 DB - PRIME DP - Unbound Medicine ER -