Comparison of Biplane Area-Length Method and 3D Volume Quantification by Using Cardiac MRI for Assessment of Left Atrial Volume in Atrial Fibrillation

Anthony Maroun; Justin J. Baraboo; Suvai Gunasekaran; Julia M. Hwang; Sophia Z. Liu; Rod S. Passman; Daniel Kim; Bradley D. Allen; Michael Markl; Maurice Pradella

doi:10.1148/ryct.220133

Comparison of Biplane Area-Length Method and 3D Volume Quantification by Using Cardiac MRI for Assessment of Left Atrial Volume in Atrial Fibrillation

Anthony Maroun^*, Justin J. Baraboo, Suvai Gunasekaran, Julia M. Hwang, Sophia Z. Liu, Rod S. Passman, Daniel Kim, Bradley D. Allen, Michael Markl, Maurice Pradella

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Purpose: To compare maximum left atrial (LA) volume (LAV) from the routinely used biplane area-length (BAL) method with threedimensional (3D)–based volumetry from late gadolinium-enhanced MRI (3D LGE MRI) and contrast-enhanced MR angiography (3D CE-MRA) in patients with atrial fibrillation (AF). Materials and Methods: Sixty-four patients with AF (mean age, 63 years ± 9 [SD]; 40 male patients) were retrospectively included from a prospective cohort acquired between October 2018 and February 2021. All patients underwent a research MRI examination that included standard two-and four-chamber cine acquisitions, 3D CE-MRA, and 3D LGE MRI performed prior to the atrial kick. Contour delineation on cine imaging and LA 3D segmentations were performed by a radiologist. Maximum LAV (BALmax) was extracted from the BAL volume-time curve and compared with LAV from 3D CE-MRA and 3D LGE MRI. The Kruskal-Wallis test was performed, followed by the Dunn post hoc test and Bland-Altman analyses. Interobserver variability was assessed in 10 patients. Results: BALmax underestimated LAV compared with 3D CE-MRA (bias:-23.5 mL ± 46.2, P <.001) and 3D LGE MRI (bias:-31.3 mL ± 58.3, P <.001), whereas 3D LGE MRI volumes showed no evidence of a difference from 3D CE-MRA (bias: 7.8 mL ± 45.7, P =.38). Interobserver variability yielded excellent agreement for each method (intraclass correlation coefficient, 0.96–0.98). Conclusion: BALmax underestimated LAV in patients with AF compared with 3D LGE MRI and 3D CE-MRA, suggesting that the geometric assumption of an ellipsoidal LA shape in BAL does not reflect LA geometry in patients with AF. Supplemental material is available for this article.

Original language	English (US)
Article number	e220133
Journal	Radiology: Cardiothoracic Imaging
Volume	5
Issue number	2
DOIs	https://doi.org/10.1148/ryct.220133
State	Published - Apr 2023

Funding

Author contributions: Guarantors of integrity of entire study, A.M., M.M., M.P.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, A.M., S.Z.L., M.M., M.P.; clinical studies, A.M., S.G., R.S.P., B.D.A., M.M., M.P.; statistical analysis, A.M., J.J.B., M.P.; and manuscript editing, all authors Disclosures of conflicts of interest: A.M. Grant from the American Heart Association, Vulnerable Substrate for AF and Stroke, no. 18SFRN34250013. J.J.B. No relevant relationships. S.G. Trainee editorial board member of Radiology: Cardiothoracic Imaging. J.M.H. No relevant relationships. S.Z.L. No relevant relationships. R.S.P. Grant from the American Heart Association; consulting fees from Abbott, Janssen, and Medtronic; participation on a data and safety monitoring board or advisory board for Abbott and Janssen. D.K. No relevant relationships. B.D.A. Grants from the American Heart Association, Society for Cardiovascular Magnetic Resonance, National Institutes of Health, and American Roentgen Ray Society (payments made to institution for salary and research support); consulting fees from Circle Cardiovascular Imaging; presentation fee from Medscape; payment for expert testimony from Expert Witness; provisional patent filed with final patent under preparation (not related to this work); editorial board member of Radiology: Cardiothoracic Imaging. M.M. Grants/contracts from Siemens and Circle Cardiovascular Imaging; associate editor of Radiology: Cardiothoracic Imaging. M.P. Research fellowship supported by American Heart Association, Bangerter Rhyner Foundation (Basel, Switzerland), and Freie Akademische Gesellschaft Basel (Basel, Switzerland), but none had direct or indirect influence on this manuscript. R.S.P. supported by American Heart Association: Vulnerable Substrate for AF and Stroke grant no. 18SFRN34250013.

Keywords

Atrial Fibrillation
Biplane Area-Length
Contrast-enhanced 3D MR Angiography
Late Gadolinium-enhanced 3D MRI
Left Atrial Volume

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1148/ryct.220133

Cite this

Maroun, A., Baraboo, J. J., Gunasekaran, S., Hwang, J. M., Liu, S. Z., Passman, R. S., Kim, D., Allen, B. D., Markl, M., & Pradella, M. (2023). Comparison of Biplane Area-Length Method and 3D Volume Quantification by Using Cardiac MRI for Assessment of Left Atrial Volume in Atrial Fibrillation. Radiology: Cardiothoracic Imaging, 5(2), Article e220133. https://doi.org/10.1148/ryct.220133

@article{17d90e927c484a50bc0c15733dcf0b4d,

title = "Comparison of Biplane Area-Length Method and 3D Volume Quantification by Using Cardiac MRI for Assessment of Left Atrial Volume in Atrial Fibrillation",

abstract = "Purpose: To compare maximum left atrial (LA) volume (LAV) from the routinely used biplane area-length (BAL) method with threedimensional (3D)–based volumetry from late gadolinium-enhanced MRI (3D LGE MRI) and contrast-enhanced MR angiography (3D CE-MRA) in patients with atrial fibrillation (AF). Materials and Methods: Sixty-four patients with AF (mean age, 63 years ± 9 [SD]; 40 male patients) were retrospectively included from a prospective cohort acquired between October 2018 and February 2021. All patients underwent a research MRI examination that included standard two-and four-chamber cine acquisitions, 3D CE-MRA, and 3D LGE MRI performed prior to the atrial kick. Contour delineation on cine imaging and LA 3D segmentations were performed by a radiologist. Maximum LAV (BALmax) was extracted from the BAL volume-time curve and compared with LAV from 3D CE-MRA and 3D LGE MRI. The Kruskal-Wallis test was performed, followed by the Dunn post hoc test and Bland-Altman analyses. Interobserver variability was assessed in 10 patients. Results: BALmax underestimated LAV compared with 3D CE-MRA (bias:-23.5 mL ± 46.2, P <.001) and 3D LGE MRI (bias:-31.3 mL ± 58.3, P <.001), whereas 3D LGE MRI volumes showed no evidence of a difference from 3D CE-MRA (bias: 7.8 mL ± 45.7, P =.38). Interobserver variability yielded excellent agreement for each method (intraclass correlation coefficient, 0.96–0.98). Conclusion: BALmax underestimated LAV in patients with AF compared with 3D LGE MRI and 3D CE-MRA, suggesting that the geometric assumption of an ellipsoidal LA shape in BAL does not reflect LA geometry in patients with AF. Supplemental material is available for this article.",

keywords = "Atrial Fibrillation, Biplane Area-Length, Contrast-enhanced 3D MR Angiography, Late Gadolinium-enhanced 3D MRI, Left Atrial Volume",

author = "Anthony Maroun and Baraboo, {Justin J.} and Suvai Gunasekaran and Hwang, {Julia M.} and Liu, {Sophia Z.} and Passman, {Rod S.} and Daniel Kim and Allen, {Bradley D.} and Michael Markl and Maurice Pradella",

note = "Funding Information: Author contributions: Guarantors of integrity of entire study, A.M., M.M., M.P.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, A.M., S.Z.L., M.M., M.P.; clinical studies, A.M., S.G., R.S.P., B.D.A., M.M., M.P.; statistical analysis, A.M., J.J.B., M.P.; and manuscript editing, all authors Disclosures of conflicts of interest: A.M. Grant from the American Heart Association, Vulnerable Substrate for AF and Stroke, no. 18SFRN34250013. J.J.B. No relevant relationships. S.G. Trainee editorial board member of Radiology: Cardiothoracic Imaging. J.M.H. No relevant relationships. S.Z.L. No relevant relationships. R.S.P. Grant from the American Heart Association; consulting fees from Abbott, Janssen, and Medtronic; participation on a data and safety monitoring board or advisory board for Abbott and Janssen. D.K. No relevant relationships. B.D.A. Grants from the American Heart Association, Society for Cardiovascular Magnetic Resonance, National Institutes of Health, and American Roentgen Ray Society (payments made to institution for salary and research support); consulting fees from Circle Cardiovascular Imaging; presentation fee from Medscape; payment for expert testimony from Expert Witness; provisional patent filed with final patent under preparation (not related to this work); editorial board member of Radiology: Cardiothoracic Imaging. M.M. Grants/contracts from Siemens and Circle Cardiovascular Imaging; associate editor of Radiology: Cardiothoracic Imaging. M.P. Research fellowship supported by American Heart Association, Bangerter Rhyner Foundation (Basel, Switzerland), and Freie Akademische Gesellschaft Basel (Basel, Switzerland), but none had direct or indirect influence on this manuscript. Funding Information: R.S.P. supported by American Heart Association: Vulnerable Substrate for AF and Stroke grant no. 18SFRN34250013. Publisher Copyright: {\textcopyright} RSNA, 2023.",

year = "2023",

month = apr,

doi = "10.1148/ryct.220133",

language = "English (US)",

volume = "5",

journal = "Radiology: Cardiothoracic Imaging",

issn = "2638-6135",

publisher = "Radiological Society of North America Inc.",

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TY - JOUR

T1 - Comparison of Biplane Area-Length Method and 3D Volume Quantification by Using Cardiac MRI for Assessment of Left Atrial Volume in Atrial Fibrillation

AU - Maroun, Anthony

AU - Baraboo, Justin J.

AU - Gunasekaran, Suvai

AU - Hwang, Julia M.

AU - Liu, Sophia Z.

AU - Passman, Rod S.

AU - Kim, Daniel

AU - Allen, Bradley D.

AU - Markl, Michael

AU - Pradella, Maurice

N1 - Funding Information: Author contributions: Guarantors of integrity of entire study, A.M., M.M., M.P.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, A.M., S.Z.L., M.M., M.P.; clinical studies, A.M., S.G., R.S.P., B.D.A., M.M., M.P.; statistical analysis, A.M., J.J.B., M.P.; and manuscript editing, all authors Disclosures of conflicts of interest: A.M. Grant from the American Heart Association, Vulnerable Substrate for AF and Stroke, no. 18SFRN34250013. J.J.B. No relevant relationships. S.G. Trainee editorial board member of Radiology: Cardiothoracic Imaging. J.M.H. No relevant relationships. S.Z.L. No relevant relationships. R.S.P. Grant from the American Heart Association; consulting fees from Abbott, Janssen, and Medtronic; participation on a data and safety monitoring board or advisory board for Abbott and Janssen. D.K. No relevant relationships. B.D.A. Grants from the American Heart Association, Society for Cardiovascular Magnetic Resonance, National Institutes of Health, and American Roentgen Ray Society (payments made to institution for salary and research support); consulting fees from Circle Cardiovascular Imaging; presentation fee from Medscape; payment for expert testimony from Expert Witness; provisional patent filed with final patent under preparation (not related to this work); editorial board member of Radiology: Cardiothoracic Imaging. M.M. Grants/contracts from Siemens and Circle Cardiovascular Imaging; associate editor of Radiology: Cardiothoracic Imaging. M.P. Research fellowship supported by American Heart Association, Bangerter Rhyner Foundation (Basel, Switzerland), and Freie Akademische Gesellschaft Basel (Basel, Switzerland), but none had direct or indirect influence on this manuscript. Funding Information: R.S.P. supported by American Heart Association: Vulnerable Substrate for AF and Stroke grant no. 18SFRN34250013. Publisher Copyright: © RSNA, 2023.

PY - 2023/4

Y1 - 2023/4

N2 - Purpose: To compare maximum left atrial (LA) volume (LAV) from the routinely used biplane area-length (BAL) method with threedimensional (3D)–based volumetry from late gadolinium-enhanced MRI (3D LGE MRI) and contrast-enhanced MR angiography (3D CE-MRA) in patients with atrial fibrillation (AF). Materials and Methods: Sixty-four patients with AF (mean age, 63 years ± 9 [SD]; 40 male patients) were retrospectively included from a prospective cohort acquired between October 2018 and February 2021. All patients underwent a research MRI examination that included standard two-and four-chamber cine acquisitions, 3D CE-MRA, and 3D LGE MRI performed prior to the atrial kick. Contour delineation on cine imaging and LA 3D segmentations were performed by a radiologist. Maximum LAV (BALmax) was extracted from the BAL volume-time curve and compared with LAV from 3D CE-MRA and 3D LGE MRI. The Kruskal-Wallis test was performed, followed by the Dunn post hoc test and Bland-Altman analyses. Interobserver variability was assessed in 10 patients. Results: BALmax underestimated LAV compared with 3D CE-MRA (bias:-23.5 mL ± 46.2, P <.001) and 3D LGE MRI (bias:-31.3 mL ± 58.3, P <.001), whereas 3D LGE MRI volumes showed no evidence of a difference from 3D CE-MRA (bias: 7.8 mL ± 45.7, P =.38). Interobserver variability yielded excellent agreement for each method (intraclass correlation coefficient, 0.96–0.98). Conclusion: BALmax underestimated LAV in patients with AF compared with 3D LGE MRI and 3D CE-MRA, suggesting that the geometric assumption of an ellipsoidal LA shape in BAL does not reflect LA geometry in patients with AF. Supplemental material is available for this article.

AB - Purpose: To compare maximum left atrial (LA) volume (LAV) from the routinely used biplane area-length (BAL) method with threedimensional (3D)–based volumetry from late gadolinium-enhanced MRI (3D LGE MRI) and contrast-enhanced MR angiography (3D CE-MRA) in patients with atrial fibrillation (AF). Materials and Methods: Sixty-four patients with AF (mean age, 63 years ± 9 [SD]; 40 male patients) were retrospectively included from a prospective cohort acquired between October 2018 and February 2021. All patients underwent a research MRI examination that included standard two-and four-chamber cine acquisitions, 3D CE-MRA, and 3D LGE MRI performed prior to the atrial kick. Contour delineation on cine imaging and LA 3D segmentations were performed by a radiologist. Maximum LAV (BALmax) was extracted from the BAL volume-time curve and compared with LAV from 3D CE-MRA and 3D LGE MRI. The Kruskal-Wallis test was performed, followed by the Dunn post hoc test and Bland-Altman analyses. Interobserver variability was assessed in 10 patients. Results: BALmax underestimated LAV compared with 3D CE-MRA (bias:-23.5 mL ± 46.2, P <.001) and 3D LGE MRI (bias:-31.3 mL ± 58.3, P <.001), whereas 3D LGE MRI volumes showed no evidence of a difference from 3D CE-MRA (bias: 7.8 mL ± 45.7, P =.38). Interobserver variability yielded excellent agreement for each method (intraclass correlation coefficient, 0.96–0.98). Conclusion: BALmax underestimated LAV in patients with AF compared with 3D LGE MRI and 3D CE-MRA, suggesting that the geometric assumption of an ellipsoidal LA shape in BAL does not reflect LA geometry in patients with AF. Supplemental material is available for this article.

KW - Atrial Fibrillation

KW - Biplane Area-Length

KW - Contrast-enhanced 3D MR Angiography

KW - Late Gadolinium-enhanced 3D MRI

KW - Left Atrial Volume

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Comparison of Biplane Area-Length Method and 3D Volume Quantification by Using Cardiac MRI for Assessment of Left Atrial Volume in Atrial Fibrillation

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