title: Morphological and volumetric analysis of left atrial appendage and left atrium: cardiac computed tomography-based reproducibility assessment.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Taina
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Miika
authors.initials: M
authors.lastname: Korhonen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Haataja
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Muuronen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Otso
authors.initials: O
authors.lastname: Arponen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Heart Center, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Hedman
authors.affiliation: NeuroCenter, Kuopio University Hospital, Kuopio, Finland; Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Jäkälä
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Sipola
authors.affiliation: Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Mustonen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Ritva
authors.initials: R
authors.lastname: Vanninen
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000473:pathology*; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006331:Heart Diseases / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed