Measurements of the left atrium and pulmonary veins for analysis of reverse structural remodeling following cardiac ablation therapy

The CABANA Pilot Imaging Investigators

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Rationale and objectives: Geometric analysis of the left atrium and pulmonary veins is important for assessing reverse structural remodeling following cardiac ablation therapy. Most volumetric analysis techniques, however, require laborious manual tracing of image cross-sections. Pulmonary vein diameters are typically measured at the junction between the left atrium and pulmonary veins, called the pulmonary vein ostia, with manually drawn lines on volume renderings or in image slices. In this work, we describe a technique for making semi-automatic measurements of left atrial volume and pulmonary vein diameters from high resolution CT scans and demonstrate its use for analyzing reverse structural remodeling following cardiac ablation therapy. Methods: The left atrium and pulmonary veins are segmented from high-resolution computed tomography (CT) volumes using a 3D volumetric approach and cut planes are interactively positioned to separate the pulmonary veins from the body of the left atrium. Left atrial volume and pulmonary vein ostial diameters are then automatically computed from the segmented structures. Validation experiments are conducted to evaluate accuracy and repeatability of the measurements. Accuracy is assessed by comparing left atrial volumes computed with the proposed methodology to a manual slice-by-slice tracing approach. Repeatability is assessed by making repeated volume and diameter measurements on duplicated and randomized datasets. The proposed techniques were then utilized in a study of 21 patients from the Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Trial (CABANA) pilot study who were scanned both before and approximately 3 months following ablation therapy. Results: In the high resolution CT scans the left atrial volume measurements show high accuracy with a mean absolute difference of 2.3±1.9cm3 between volumes computed with the proposed methodology and a manual slice-by-slice tracing approach. In the intra-rater repeatability study, the mean absolute difference in left atrial volume was 4.7±2.5cm3 and 4.4±3.4cm3 for the two raters. Intra-rater repeatability for pulmonary vein diameters ranged from 0.9 to 2.3mm. The inter-rater repeatability for left atrial volume was 5.8±5.1cm3 and inter-rater repeatability for pulmonary vein diameter measurements ranged from 1.4 to 2.3mm. In the patient study, significant (p<.05) decreases in left atrial volume and all four pulmonary vein diameters were observed. The absolute change in LA volume was 20.0cm3, 95%CI [12.6, 27.5]. The left inferior pulmonary vein diameter decreased 2.1mm, 95%CI [0.4, 3.7], the left superior pulmonary vein diameter decreased 3.2mm, 95%CI [1.0, 5.4], the right inferior pulmonary vein diameter decreased 1.5mm, 95%CI [0.3, 2.7], and the right superior pulmonary vein diameter decreased 2.8mm, 95%CI [1.4, 4.3]. Conclusions: Using the proposed techniques, we demonstrate high accuracy of left atrial volume measurements as well as high repeatability for left atrial volume and pulmonary vein diameter measurements. Following cardiac ablation therapy, a significant decrease was observed for left atrial volume as well as all four pulmonary vein diameters.

Original languageEnglish (US)
Pages (from-to)198-206
Number of pages9
JournalComputer Methods and Programs in Biomedicine
Volume118
Issue number2
DOIs
StatePublished - 2015

Fingerprint

Pulmonary Veins
Ablation
Heart Atria
Tomography
Volume measurement
Volumetric analysis
Drug therapy
Therapeutics
Volume rendering
Catheters
Experiments
Cone-Beam Computed Tomography
Catheter Ablation
Anti-Arrhythmia Agents

Keywords

  • Atrial fibrillation
  • Cardiac ablation therapy
  • Left atrial segmentation
  • Left atrial volume
  • Left atrium
  • Pulmonary vein diameter

ASJC Scopus subject areas

  • Computer Science Applications
  • Software
  • Health Informatics

Cite this

Measurements of the left atrium and pulmonary veins for analysis of reverse structural remodeling following cardiac ablation therapy. / The CABANA Pilot Imaging Investigators.

In: Computer Methods and Programs in Biomedicine, Vol. 118, No. 2, 2015, p. 198-206.

Research output: Contribution to journalArticle

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title = "Measurements of the left atrium and pulmonary veins for analysis of reverse structural remodeling following cardiac ablation therapy",
abstract = "Rationale and objectives: Geometric analysis of the left atrium and pulmonary veins is important for assessing reverse structural remodeling following cardiac ablation therapy. Most volumetric analysis techniques, however, require laborious manual tracing of image cross-sections. Pulmonary vein diameters are typically measured at the junction between the left atrium and pulmonary veins, called the pulmonary vein ostia, with manually drawn lines on volume renderings or in image slices. In this work, we describe a technique for making semi-automatic measurements of left atrial volume and pulmonary vein diameters from high resolution CT scans and demonstrate its use for analyzing reverse structural remodeling following cardiac ablation therapy. Methods: The left atrium and pulmonary veins are segmented from high-resolution computed tomography (CT) volumes using a 3D volumetric approach and cut planes are interactively positioned to separate the pulmonary veins from the body of the left atrium. Left atrial volume and pulmonary vein ostial diameters are then automatically computed from the segmented structures. Validation experiments are conducted to evaluate accuracy and repeatability of the measurements. Accuracy is assessed by comparing left atrial volumes computed with the proposed methodology to a manual slice-by-slice tracing approach. Repeatability is assessed by making repeated volume and diameter measurements on duplicated and randomized datasets. The proposed techniques were then utilized in a study of 21 patients from the Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Trial (CABANA) pilot study who were scanned both before and approximately 3 months following ablation therapy. Results: In the high resolution CT scans the left atrial volume measurements show high accuracy with a mean absolute difference of 2.3±1.9cm3 between volumes computed with the proposed methodology and a manual slice-by-slice tracing approach. In the intra-rater repeatability study, the mean absolute difference in left atrial volume was 4.7±2.5cm3 and 4.4±3.4cm3 for the two raters. Intra-rater repeatability for pulmonary vein diameters ranged from 0.9 to 2.3mm. The inter-rater repeatability for left atrial volume was 5.8±5.1cm3 and inter-rater repeatability for pulmonary vein diameter measurements ranged from 1.4 to 2.3mm. In the patient study, significant (p<.05) decreases in left atrial volume and all four pulmonary vein diameters were observed. The absolute change in LA volume was 20.0cm3, 95{\%}CI [12.6, 27.5]. The left inferior pulmonary vein diameter decreased 2.1mm, 95{\%}CI [0.4, 3.7], the left superior pulmonary vein diameter decreased 3.2mm, 95{\%}CI [1.0, 5.4], the right inferior pulmonary vein diameter decreased 1.5mm, 95{\%}CI [0.3, 2.7], and the right superior pulmonary vein diameter decreased 2.8mm, 95{\%}CI [1.4, 4.3]. Conclusions: Using the proposed techniques, we demonstrate high accuracy of left atrial volume measurements as well as high repeatability for left atrial volume and pulmonary vein diameter measurements. Following cardiac ablation therapy, a significant decrease was observed for left atrial volume as well as all four pulmonary vein diameters.",
keywords = "Atrial fibrillation, Cardiac ablation therapy, Left atrial segmentation, Left atrial volume, Left atrium, Pulmonary vein diameter",
author = "{The CABANA Pilot Imaging Investigators} and Rettmann, {Maryam E.} and {Holmes III}, {David R.} and Breen, {Jerome F.} and Xin Ge and Karwoski, {Ronald A.} and Monahan, {Kristi H.} and Bahnson, {Tristram D.} and Packer, {Douglas L} and Robb, {Richard A.} and Steven Bailin and Anil Bhandari and John Day and John Hum-Mel and Neil Kay and David Wilber",
year = "2015",
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TY - JOUR

T1 - Measurements of the left atrium and pulmonary veins for analysis of reverse structural remodeling following cardiac ablation therapy

AU - The CABANA Pilot Imaging Investigators

AU - Rettmann, Maryam E.

AU - Holmes III, David R.

AU - Breen, Jerome F.

AU - Ge, Xin

AU - Karwoski, Ronald A.

AU - Monahan, Kristi H.

AU - Bahnson, Tristram D.

AU - Packer, Douglas L

AU - Robb, Richard A.

AU - Bailin, Steven

AU - Bhandari, Anil

AU - Day, John

AU - Hum-Mel, John

AU - Kay, Neil

AU - Wilber, David

PY - 2015

Y1 - 2015

N2 - Rationale and objectives: Geometric analysis of the left atrium and pulmonary veins is important for assessing reverse structural remodeling following cardiac ablation therapy. Most volumetric analysis techniques, however, require laborious manual tracing of image cross-sections. Pulmonary vein diameters are typically measured at the junction between the left atrium and pulmonary veins, called the pulmonary vein ostia, with manually drawn lines on volume renderings or in image slices. In this work, we describe a technique for making semi-automatic measurements of left atrial volume and pulmonary vein diameters from high resolution CT scans and demonstrate its use for analyzing reverse structural remodeling following cardiac ablation therapy. Methods: The left atrium and pulmonary veins are segmented from high-resolution computed tomography (CT) volumes using a 3D volumetric approach and cut planes are interactively positioned to separate the pulmonary veins from the body of the left atrium. Left atrial volume and pulmonary vein ostial diameters are then automatically computed from the segmented structures. Validation experiments are conducted to evaluate accuracy and repeatability of the measurements. Accuracy is assessed by comparing left atrial volumes computed with the proposed methodology to a manual slice-by-slice tracing approach. Repeatability is assessed by making repeated volume and diameter measurements on duplicated and randomized datasets. The proposed techniques were then utilized in a study of 21 patients from the Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Trial (CABANA) pilot study who were scanned both before and approximately 3 months following ablation therapy. Results: In the high resolution CT scans the left atrial volume measurements show high accuracy with a mean absolute difference of 2.3±1.9cm3 between volumes computed with the proposed methodology and a manual slice-by-slice tracing approach. In the intra-rater repeatability study, the mean absolute difference in left atrial volume was 4.7±2.5cm3 and 4.4±3.4cm3 for the two raters. Intra-rater repeatability for pulmonary vein diameters ranged from 0.9 to 2.3mm. The inter-rater repeatability for left atrial volume was 5.8±5.1cm3 and inter-rater repeatability for pulmonary vein diameter measurements ranged from 1.4 to 2.3mm. In the patient study, significant (p<.05) decreases in left atrial volume and all four pulmonary vein diameters were observed. The absolute change in LA volume was 20.0cm3, 95%CI [12.6, 27.5]. The left inferior pulmonary vein diameter decreased 2.1mm, 95%CI [0.4, 3.7], the left superior pulmonary vein diameter decreased 3.2mm, 95%CI [1.0, 5.4], the right inferior pulmonary vein diameter decreased 1.5mm, 95%CI [0.3, 2.7], and the right superior pulmonary vein diameter decreased 2.8mm, 95%CI [1.4, 4.3]. Conclusions: Using the proposed techniques, we demonstrate high accuracy of left atrial volume measurements as well as high repeatability for left atrial volume and pulmonary vein diameter measurements. Following cardiac ablation therapy, a significant decrease was observed for left atrial volume as well as all four pulmonary vein diameters.

AB - Rationale and objectives: Geometric analysis of the left atrium and pulmonary veins is important for assessing reverse structural remodeling following cardiac ablation therapy. Most volumetric analysis techniques, however, require laborious manual tracing of image cross-sections. Pulmonary vein diameters are typically measured at the junction between the left atrium and pulmonary veins, called the pulmonary vein ostia, with manually drawn lines on volume renderings or in image slices. In this work, we describe a technique for making semi-automatic measurements of left atrial volume and pulmonary vein diameters from high resolution CT scans and demonstrate its use for analyzing reverse structural remodeling following cardiac ablation therapy. Methods: The left atrium and pulmonary veins are segmented from high-resolution computed tomography (CT) volumes using a 3D volumetric approach and cut planes are interactively positioned to separate the pulmonary veins from the body of the left atrium. Left atrial volume and pulmonary vein ostial diameters are then automatically computed from the segmented structures. Validation experiments are conducted to evaluate accuracy and repeatability of the measurements. Accuracy is assessed by comparing left atrial volumes computed with the proposed methodology to a manual slice-by-slice tracing approach. Repeatability is assessed by making repeated volume and diameter measurements on duplicated and randomized datasets. The proposed techniques were then utilized in a study of 21 patients from the Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation Trial (CABANA) pilot study who were scanned both before and approximately 3 months following ablation therapy. Results: In the high resolution CT scans the left atrial volume measurements show high accuracy with a mean absolute difference of 2.3±1.9cm3 between volumes computed with the proposed methodology and a manual slice-by-slice tracing approach. In the intra-rater repeatability study, the mean absolute difference in left atrial volume was 4.7±2.5cm3 and 4.4±3.4cm3 for the two raters. Intra-rater repeatability for pulmonary vein diameters ranged from 0.9 to 2.3mm. The inter-rater repeatability for left atrial volume was 5.8±5.1cm3 and inter-rater repeatability for pulmonary vein diameter measurements ranged from 1.4 to 2.3mm. In the patient study, significant (p<.05) decreases in left atrial volume and all four pulmonary vein diameters were observed. The absolute change in LA volume was 20.0cm3, 95%CI [12.6, 27.5]. The left inferior pulmonary vein diameter decreased 2.1mm, 95%CI [0.4, 3.7], the left superior pulmonary vein diameter decreased 3.2mm, 95%CI [1.0, 5.4], the right inferior pulmonary vein diameter decreased 1.5mm, 95%CI [0.3, 2.7], and the right superior pulmonary vein diameter decreased 2.8mm, 95%CI [1.4, 4.3]. Conclusions: Using the proposed techniques, we demonstrate high accuracy of left atrial volume measurements as well as high repeatability for left atrial volume and pulmonary vein diameter measurements. Following cardiac ablation therapy, a significant decrease was observed for left atrial volume as well as all four pulmonary vein diameters.

KW - Atrial fibrillation

KW - Cardiac ablation therapy

KW - Left atrial segmentation

KW - Left atrial volume

KW - Left atrium

KW - Pulmonary vein diameter

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