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Clinical utility of 2-D anatomic measurements in predicting cough-associated headache in Chiari I malformation

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

Cough-associated headache (CAH) is the most distinctive symptom of patients with Chiari I malformation (CMI) and indicates clinically significant disease. We determined the clinical utility of simple 2D anatomic measurements performed on a PACS workstation by assessing their diagnostic accuracy in predicting CAH in CMI patients.

Methods

Seventy-two consecutive CMI patients (cerebellar tonsillar herniation > 5 mm) with headache seen by neurosurgeons over 6 years were included. Sagittal T1 images were used by two readers to measure: extent of tonsillar herniation, lengths of the clivus and supra-occiput, McRae and pB-C2 lines, as well as clivus-canal, odontoid retroversion, and skull base angles. Neurosurgery notes were reviewed to determine presence of CAH. Mann-Whitney test was used to compare measurements between patients with and without CAH. Predictive accuracy was assessed by receiver operating characteristic (ROC) curve.

Results

47/72 (65.3%) CMI patients reported CAH. Tonsillar herniation with CAH (10.2 mm, 7–14 mm; median, interquartile range) was significantly greater than those without CAH (7.9 mm, 6.3–10.9 mm; p = 0.02). Tonsillar herniation ≥ 10 mm showed sensitivity and specificity of 51% and 68%, and tonsillar herniation > 14 mm showed sensitivity and specificity of 30% and 100%, respectively, for predicting CAH. Other 2D measurements showed no statistically significant differences.

Conclusions

Among the 2D measurements used, only the extent of tonsillar herniation is different between CMI patients with and without CAH. Although CMI is diagnosed with tonsillar herniation of only 5 mm, we found that a much higher extent of herniation is needed to be predictive of CAH.

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Authors and Affiliations

  1. Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Chi Wen C. Huang, Yu-Ming Chang, Alexander Brook, A. Fourie Bezuidenhout & Rafeeque A. Bhadelia

  2. Department of Radiology, Wan Fang Hospital, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City, Taiwan, 110

    Chi Wen C. Huang

  3. Department of Radiology, Beth Israel Deaconess Medical Center, WCB90, 330 Brookline Ave, Boston, MA, 02215, USA

    Rafeeque A. Bhadelia

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  1. Chi Wen C. Huang
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  2. Yu-Ming Chang
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Correspondence to Rafeeque A. Bhadelia.

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Huang, C.W.C., Chang, YM., Brook, A. et al. Clinical utility of 2-D anatomic measurements in predicting cough-associated headache in Chiari I malformation. Neuroradiology 62, 593–599 (2020). https://doi.org/10.1007/s00234-019-02356-0

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