Cranial base foramen location accuracy and reliability in cone-beam computerized tomography

IntroductionThe purpose of this study was to evaluate the reliability and accuracy in locating several different foramina in the cranial base by using cone-beam computerized tomography (CBCT) images for future use in establishing reference coordinate systems.MethodsCBCT images from 10 dry skulls were taken with and without the foramina ovale, spinosum, and rotundum, and the hypoglossal canals filled with radiopaque gutta-percha (gold standard). Three evaluators identified the foramen landmarks in the CBCT images without gutta-percha. Mean differences and main researcher intraexaminer and interexaminer reliability were measured by using intraclass correlation coefficients for all landmark coordinates. Descriptive statistics were calculated with respect to the landmark coordinates and distances to the reference points.ResultsIntraexaminer and interexaminer reliability values for the x-, y-, and z-coordinates for all landmarks were greater than 0.9 with the exception of 4 (of 72) points that still had acceptable interexaminer reliability (>0.75). Mean measurement error differences obtained in the principal investigator’s trials were primarily less than 0.5 mm. When comparing the mean distance differences of the same examiner and between the 3 examiners with the gold standard, the highest difference obtained was 1.3 mm.ConclusionsForamina spinosum, ovale, and rotundum, and the hypoglossal canal all provided high intraexaminer reliability and accuracy, and can be considered acceptable landmarks to use in establishing reference coordinate systems for future 3-dimensional superimposition analysis.