左心耳及左心房的形态学和容积分析：基于心脏计算机断层扫描的可重复性评估
Morphological and volumetric analysis of left atrial appendage and left atrium: cardiac computed tomography-based reproducibility assessment.
作者信息
Taina Mikko, Korhonen Miika, Haataja Mika, Muuronen Antti, Arponen Otso, Hedman Marja, Jäkälä Pekka, Sipola Petri, Mustonen Pirjo, Vanninen Ritva
机构信息
Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Heart Center, Kuopio University Hospital, Kuopio, Finland.
出版信息
PLoS One. 2014 Jul 2;9(7):e101580. doi: 10.1371/journal.pone.0101580. eCollection 2014.
OBJECTIVES
Left atrial appendage (LAA) dilatation and morphology may influence an individual's risk for intracardiac thrombi and ischemic stroke. LAA size and morphology can be evaluated using cardiac computed tomography (cCT). The present study evaluated the reproducibility of LAA volume and morphology assessments.
METHODS
A total of 149 patients (47 females; mean age 60.9±10.6 years) with suspected cardioembolic stroke/transient ischemic attack underwent cCT. Image quality was rated based on four categories. Ten patients were selected from each image quality category (N = 40) for volumetric reproducibility analysis by two individual readers. LAA and left atrium (LA) volume were measured in both two-chamber (2CV) and transversal view (TV) orientation. Intertechnique reproducibility was assessed between 2CV and TV (200 measurement pairs). LAA morphology (A = Cactus, B = ChickenWing, C = WindSock, D = CauliFlower), LAA opening height, number of LAA lobes, trabeculation, and orientation of the LAA tip was analysed in all study subjects by three individual readers (447 interobserver measurement pairs). The reproducibility of volume measurements was assessed by intra-class correlation (ICC) and the reproducibility of LAA morphology assessments by Cohen's kappa.
RESULTS
The intra-observer and interobserver reproducibility of LAA and LA volume measurements was excellent (ICCs>0.9). The LAA (ICC = 0.954) and LA (ICC = 0.945) volume measurements were comparable between 2CV and TV. Morphological classification (ĸ = 0.24) and assessments of LAA opening height (ĸ = 0.1), number of LAA lobes (ĸ = 0.16), trabeculation (ĸ = 0.15), and orientation of the LAA tip (ĸ = 0.37) was only slightly to fairly reproducible.
CONCLUSIONS
LA and LAA volume measurements on cCT provide excellent reproducibility, whereas visual assessment of LAA morphological features is challenging and results in unsatisfactory agreement between readers.
目的
左心耳（LAA）扩张和形态可能影响个体发生心内血栓和缺血性卒中的风险。LAA大小和形态可通过心脏计算机断层扫描（cCT）进行评估。本研究评估了LAA容积和形态评估的可重复性。
方法
共有149例疑似心源性栓塞性卒中/短暂性脑缺血发作的患者（47例女性；平均年龄60.9±10.6岁）接受了cCT检查。图像质量根据四类进行评分。从每个图像质量类别中选取10例患者（N = 40），由两位独立阅片者进行容积可重复性分析。在双腔（2CV）和横断面（TV）方向测量LAA和左心房（LA）容积。评估2CV和TV之间的技术间可重复性（200对测量值）。由三位独立阅片者对所有研究对象的LAA形态（A = 仙人掌型，B = 鸡翅型，C = 风袋型，D = 菜花型）、LAA开口高度、LAA叶数、小梁结构以及LAA尖端方向进行分析（447对观察者间测量值）。容积测量的可重复性通过组内相关系数（ICC）进行评估，LAA形态评估的可重复性通过Cohen's kappa系数进行评估。
结果
LAA和LA容积测量的观察者内和观察者间可重复性均极佳（ICC>0.9）。2CV和TV之间的LAA（ICC = 0.954）和LA（ICC = 0.945）容积测量结果具有可比性。形态学分类（ĸ = 0.24）以及LAA开口高度（ĸ = 0.1）、LAA叶数（ĸ = 0.16）、小梁结构（ĸ = 0.15）和LAA尖端方向（ĸ = 0.37）的评估仅具有轻微到中等程度的可重复性。
结论
cCT上LA和LAA容积测量具有极佳的可重复性，而LAA形态特征的视觉评估具有挑战性，且阅片者之间的一致性不尽人意。
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