Related Experiment Video
Updated: Mar 21, 2026
Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
Clivus height value: a new diagnostic method for basilar invagination at CT
Insights
Clivus height (CH) measured on CT scans reliably diagnoses basilar invagination (BI). This reproducible method shows high sensitivity and specificity, aiding in diagnosing BI patients.
Area of Science:
- Radiology
- Neurosurgery
- Orthopedics
Background:
- Basilar invagination (BI) is a condition where the upper part of the cervical spine protrudes into the base of the skull.
- Accurate diagnosis of BI is crucial for appropriate management and treatment planning.
- Computed tomography (CT) is a key imaging modality for evaluating craniovertebral junction abnormalities.
Purpose of the Study:
- To evaluate the utility of clivus height (CH) measurement on CT scans for diagnosing basilar invagination (BI).
- To assess the reproducibility and diagnostic performance of CH in differentiating BI patients from healthy controls.
Main Methods:
- A retrospective study involving 65 BI patients and 85 control subjects.
- Clivus height (CH) was measured on mid-sagittal reconstructed CT images.
- Statistical analysis included independent-samples t-test, intraclass correlation coefficient (ICC) for reliability, and ROC curve analysis for diagnostic performance.
Main Results:
- CH measurements demonstrated excellent inter-observer (ICC=0.96) and intra-observer (ICC=0.98) reliability.
- BI patients exhibited significantly greater CH (1.2±0.55 cm) compared to controls (0.35±0.29 cm; p<0.001).
- ROC analysis yielded an area under the curve of 0.949, with a cut-off value of 0.65 cm providing 88% sensitivity and 88% specificity.
Conclusions:
- Measurement of clivus height (CH) on CT is a reproducible method for diagnosing basilar invagination (BI).
- CH measurement demonstrates good diagnostic performance, comparable to other established methods like CL.
- This CT-based measurement provides a valuable tool for identifying patients with BI.
Aim:
To investigate whether clivus height (CH; the distance of the basion above Chamberlain's line) could be used to diagnose basilar invagination (BI) at computed tomography (CT).
Materials And Methods:
This retrospective study received institutional review board approval, and was performed from 1 January 2013, to 1 July 2015 with a waiver of informed consent. CH was measured on mid-sagittal reconstructed CT images from 65 BI patients and 85 control subjects to compare the two groups by using the independent-samples t-test. Inter- and intra-observer reliability were evaluated with the intraclass correlation coefficient (ICC). To evaluate the diagnostic performance and determine the cut-off value of CH, receiver operating characteristic (ROC) curves were utilised.
Results:
The measurement of CH showed good inter- and intra-observer agreement (ICC=0.96 and 0.98, respectively). Compared with control subjects whose mean CH value was 0.35±0.29 cm (range, -0.18 to 1.2 cm), BI patients had a significantly (p<0.001) larger CH, 1.2±0.55 cm (range, 0.43-3.2 cm). The area under the ROC curve was 0.949 (95% confidence interval: 0.916, 0.982), and based on the cut-off value of 0.65 cm, the sensitivity, specificity, positive predictive value, and negative predictive value were 0.88 (57/65), 0.88 (75/85), 0.85 (57/67), and 0.91 (75/82), respectively.
Conclusion:
Although not better than CL (the distance of the odontoid tip above Chamberlain's line), measurement of CH at CT is reproducible and can diagnose patients with BI.
