Magnetic resonance imaging study of the craniocervical junction

To confirm the accuracy of the standard parameters of Chamberlain's line, McGregor's line, McRae's line, and Ranawat's line in the diagnosis of basilar impression in a normal Asian population using magnetic resonance imaging (MRI) scans of the craniocervical junction, and to evaluate the use of MRI in the initial diagnosis of basilar impression.

We retrospectively reviewed MRI scans of the craniocervical junction in 114 Thai patients (61 men and 53 women) aged 20 to 89 years to assess the lines of Chamberlain, McGregor, McRae, and Ranawat. Patients with injury, tumour, or metastasis in the craniocervial junction; congenital anomalies; or clinical symptoms and signs of basilar impression were excluded.

39 of the 114 patients had the odontoid tip extended above Chamberlain's line by 1 mm to 9 mm (mean, 2.89 mm). Only 7 men and 5 women had the tip of the odontoid process extended beyond the normal range of 5 mm. The mean distance of the odontoid tip extended past McGregor's line in male and female subjects was 0.33 mm (standard deviation [SD], 1.2 mm) and 0.17 mm (SD, 0.7 mm), respectively, markedly less than those reported previously, although one male patient's odontoid tip extended 8 mm above the McGregor's line. Regarding McRae's line, no patient had the odontoid tip extended above the foremen magnum. The mean Ranawat's line in male and female subjects was 15.75 mm (range, 12-19; SD, 1.71 mm) and 14.09 mm (range, 11-17; SD, 1.38 mm), respectively.

After using MRI to confirm the standard parameters of basilar impression as previously formulated from lateral skull radiographs, we recommend using McRae's line and Ranawat's line in the initial screening for basilar impression for the Asian population. Chamberlain's line and McGregor's line are viable alternatives, but clinicians must be aware of the potential for false positives.