Journal of Cardiovascular Computed Tomography
Volume 3, Issue 2 , Pages 80-87, March 2009

Quantitative assessment of left atrial volume by electrocardiographic-gated contrast-enhanced multidetector computed tomography

Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA

Received 18 August 2008; accepted 10 February 2009. published online 17 February 2009.

Background

Left atrial (LA) volume is a predictor of cardiovascular events. Information on LA volume is available on contrast-enhanced electrocardiogram (EGC)–gated multidetector computed tomography (MDCT) scans.

Objective

To assess interobserver and intraobserver reproducibility of 3-dimensional threshold-based volume (3DTV) and 2-dimensional (2D) measurements for the assessment of LA volumes with contrast-enhanced cardiac 64-slice MDCT.

Methods

Contrast-enhanced 64-slice MDCT (0.6-mm slice thickness, 120 kVp, 850 mAseff) was performed in 96 consecutive subjects (mean age 52 years; 48% women) as a subset of the Rule Out Myocardial Infarction using Computer Assisted Tomography trial. Two observers independently measured maximal (LAVmax) and minimal (LAVmin) LA volumes with (1) a modified Simpson's method (3DTV) based on delineation of LA areas in axial slices and (2) estimated LA volumes typically used in 2D echocardiography (area length and prolate ellipse). Interobserver and intraobserver reproducibility for each method as well as correlations between the methods were calculated.

Results

Interobserver (n = 96) and intraobserver (n = 20) variability was significantly lower for 3DTV (8%) than for area length (13%; P < 0.001) or prolate ellipse (16%; P < 0.001). 2D-based measurements rendered significantly lower LA volumes than did 3DTV (area length: −17% and −22%; prolate ellipse: −43% and −46% for LAVmax and LAVmin, respectively; P < 0.001 for all). By 3DTV, mean LA volume was 90.4 ± 24.5 mL for LAVmax and 52.5 ± 17.6mL for LAVmin.

Conclusion

ECG-gated contrast-enhanced cardiac MDCT offers volumetric assessment of LA volume with excellent reproducibility without additional contrast administration or radiation exposure. 3D measures of LA volume are more reproducible and render larger volumes than 2D-derived estimates, typically used in echocardiography.

Keywords: Area length, Left atrium, Multidetector computed tomography, MDCT, Prolate ellipse, Reproducibility, Volumetric

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 Conflict of interest: The authors report no conflicts of interest.

 This work was supported by the National Institutes of Health (R01 HL080053), by a grant of the German National Academic Foundation (A.A. Mahabadi), by the National Institutes of Health (T32HL076136 and L30HL093896 to Dr Truong), and by The National Heart Foundation of New Zealand (grant 1152 to Dr Seneviratne).

PII: S1934-5925(09)00078-1

doi:10.1016/j.jcct.2009.02.002

Journal of Cardiovascular Computed Tomography
Volume 3, Issue 2 , Pages 80-87, March 2009

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