A new reference line for coronal head CT to align with MRI: development of a standardised approach

Kerem Ozturk, Anthony Spano, David Nascene

Research output: Contribution to journalArticlepeer-review


BACKGROUND AND PURPOSE: There are great variations in how different technologists create the different imaging planes that can make a precise comparison of computed tomography and magnetic resonance imaging difficult. We aimed to identify a reference line for the coronal images on a computed tomography topography parallel to the posterior borderline of the brainstem (PB), matching standard coronal magnetic resonance imaging planes.

METHODS: We retrospectively reviewed computed tomography topography images of 80 consecutive patients to determine a computed tomography plane to match the PB on magnetic resonance imaging. These included the tuberculum sella (TS)-anterior arch of the C1 vertebra (C1), TS-tip of dens axis (D), dorsum sellae (DS)-C1 and DS-D. We compared these methods of prescribing the coronal computed tomography plane to coronal magnetic resonance imaging planes by measuring the angles between TS-C1 and PB, TS-M and PB, DS-C1 and PB, DS-D and PB on midsagittal brain magnetic resonance images. Bland-Altman plots were created to assess intra-observer reliability.

RESULTS: The angles between the PB line and each topogram-determined line are as follows: TS-C1, 10.40° ± 4.86°; TS-D, 22.46° ± 5.23°; DS-C1, 3.01° ± 3.16°; and DS-D, 11.53° ± 4.10°. The mean angles between the DS-C1 and the PB lines were significantly smaller than the mean angle between any other line (DS-D, TS-C1, or TS-D, all P < 0.001). Intra-observer agreement regarding the angular position of the reformatted coronal images on the lateral scout image was excellent (intraclass correlation coefficient >0.900, P < 0.05).

CONCLUSIONS: The DS-C1 is almost parallel to the PB and easily identifiable on the lateral scout topography of brain computed tomography. Utilising the DS-C1 line as the baseline for brain computed tomography could allow better corroboration with coronal magnetic resonance imaging angulation.

Original languageEnglish (US)
Pages (from-to)1971400920972837
JournalNeuroradiology Journal
Early online dateNov 11 2020
StateE-pub ahead of print - Nov 11 2020

Bibliographical note

Publisher Copyright:
© The Author(s) 2020.


  • computed tomography (CT)
  • reference line
  • technologist
  • tip of dens (D)
  • Tuberculum sella (TS)

PubMed: MeSH publication types

  • Journal Article


Dive into the research topics of 'A new reference line for coronal head CT to align with MRI: development of a standardised approach'. Together they form a unique fingerprint.

Cite this