Vascular Landmark-Based Method for Highly Reproducible Measurement of Left Atrial Appendage Volume in Computed Tomography.
Vascular Landmark-Based Method for Highly Reproducible Measurement of Left Atrial Appendage Volume in Computed Tomography.
复制标题
基于血管标志的方法，用于在计算机断层扫描中高度重复地测量左心耳体积。
DOI：
10.1161/circimaging.119.009075
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
McVeigh,ElliotR
中科院分区：
文献类型：
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作者：
Schluchter,Andrew;Jan,Chelsea;Lowe,Katherine;Vigneault,DavisM;Contijoch,Francisco;McVeigh,ElliotR
背景现代计算机断层扫描可以产生左心耳（LAA）的4维图像。然后可以测量LAA功能和形态，以计划封堵等干预措施并评估LAA流量以进行血栓形成风险分析。这里目前的问题是定义一个可重复的边界之间的LAA和左atrial.MethodsThis研究回顾性门控4维计算机断层扫描数据从25植入和冠状动脉成像患者。在每例患者中，在RR间期的多个时间点确定LAA口。为了检查左心耳口定义的重现性，3名观察员对每例患者的所有时间范围进行了3次分析。然后使用组内相关系数比较每个患者的五个非连续时间范围，以量化该方法在患者中的精确度。在不同的观察者（interobserver）和每个观察者自己的数据集（intraobserver）内，确定每个患者的每个时间范围的LAA体积的相关性。观察者间测量的双向随机效应、绝对一致性、单次测量组内相关系数分别为0.984、0.990和0.988，观察者内组内相关系数分别为0.989、0.989和0.995。所有观察结果的组内相关系数为0.988。结论在ECG门控计算机断层扫描中，使用识别香豆素脊和2个血管标志的逐步过程对LAA口进行分类，提供了一种可行的方法，可以在心房和LAA之间建立高度可重复的边界，从而获得对手术计划和测量LAA功能有用的LAA指标。
BackgroundModern computed tomographic scanning can produce 4-dimensional images of the left atrial appendage (LAA). LAA function and morphology can then be measured, to plan interventions such as occlusion and to evaluate LAA flow for thrombogenic risk analysis. A current problem here is defining a reproducible boundary between the LAA and the left atrium.MethodsThis study used retrospectively gated 4-dimensional computed tomographic data from 25 implantation and coronary artery imaging patients. In each patient, the LAA ostium was defined at multiple time points during the RR interval. To examine the reproducibility of the definition of the LAA ostium, 3 observers analyzed all time frames in each patient 3 times. Five nonconsecutive time frames from each patient were then compared using intraclass correlation coefficients to quantify the precision of the method across patients. The correlation of LAA volumes for each time frame of each patient was determined across the different observers (interobserver) and within each observer’s own data sets (intraobserver).ResultsThe method was successful in 92% of patients. Two-way random-effect, absolute-agreement, single-measurement intraclass correlation coefficients for interobserver measurements were 0.984, 0.990, and 0.988, with intraobserver intraclass correlation coefficients of 0.989, 0.989, and 0.995. The intraclass correlation coefficient of all observations was 0.988.ConclusionsClassification of the LAA ostium using a stepwise procedure identifying the coumadin ridge and 2 vascular landmarks in ECG-gated computed tomography provides a viable method of establishing a highly reproducible boundary between the atrium and LAA needed to obtain LAA metrics useful for procedure planning and measuring LAA function.