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

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.