Reproducibility of Frankfort Horizontal Plane on 3D Multi-Planar Reconstructed MR Images

Amro Daboul, Christian Schwahn, Grit Schaffner, Silvia Soehnel, Stefanie Samietz, Ahmad Aljaghsi, Mohammad Habes, Katrin Hegenscheid, Ralf Puls, Thomas Klinke, Reiner Biffar

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Objective: The purpose of this study was to determine the accuracy and reliability of Frankfort horizontal plane identification using displays of multi-planar reconstructed MRI images, and propose it as a sufficiently stable and standardized reference plane for craniofacial structures. Materials and Methods: MRI images of 43 subjects were obtained from the longitudinal population based cohort study SHIP-2 using a T1-weighted 3D sequence. Five examiners independently identified the three landmarks that form FH plane. Intra-examiner reproducibility and inter-examiner reliability, correlation coefficients (ICC), coefficient of variability and Bland-Altman plots were obtained for all landmarks coordinates to assess reproducibility. Intra-examiner reproducibility and inter-examiner reliability in terms of location and plane angulation were also assessed. Results: Intra- and inter-examiner reliabilities for X, Y and Z coordinates of all three landmarks were excellent with ICC values ranging from 0.914 to 0.998. Differences among examiners were more in X and Z than in Y dimensions. The Bland-Altman analysis demonstrated excellent intra- as well as inter-examiner agreement between examiners in all coordinates for all landmarks. Intra-examiner reproducibility and inter-examiner reliability of the three landmarks in terms of distance showed mean differences between 1.3 to 2.9 mm, Mean differences in plane angulation were between 1.0° to 1.5° among examiners. Conclusion: This study revealed excellent intra-examiner reproducibility and inter-examiner reliability of Frankfort Horizontal plane through 3D landmark identification in MRI. Sufficiently stable landmark-based reference plane could be used for different treatments and studies.

Original languageEnglish (US)
Article numbere48281
JournalPloS one
Issue number10
StatePublished - Oct 31 2012
Externally publishedYes

ASJC Scopus subject areas

  • General
  • General Biochemistry, Genetics and Molecular Biology
  • General Agricultural and Biological Sciences


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