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

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

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)593-599
Number of pages7
Issue number5
Publication statusPublished - May 1 2020


  • Chiari 1 malformation
  • Cough
  • Cranio-vertebral junction
  • Headache
  • Morphometry

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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