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Updated: Apr 27, 2026
Author Spotlight: Advancements in Intracardiac Echocardiography for Atrial Anatomy Assessment
Published on: June 30, 2023
Morphological and volumetric analysis of left atrial appendage and left atrium: cardiac computed tomography-based
Mikko Taina1, Miika Korhonen1, Mika Haataja1
1Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Insights
Left atrial appendage (LAA) volume measurements using cardiac computed tomography (cCT) are highly reproducible. However, assessing LAA morphology visually shows poor reader agreement, limiting its clinical utility for stroke risk assessment.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Stroke Prevention
Background:
- Left atrial appendage (LAA) morphology and size are linked to stroke risk.
- Cardiac computed tomography (cCT) is used to evaluate LAA characteristics.
- Reproducibility of LAA assessments is crucial for clinical application.
Purpose of the Study:
- To assess the reproducibility of LAA volume and morphology measurements using cCT.
- To determine the reliability of different measurement techniques and reader agreement.
Main Methods:
- 149 patients with suspected cardioembolic stroke underwent cCT.
- LAA and left atrial (LA) volumes were measured by two readers using two views (2CV and TV).
- Morphological features, LAA opening height, lobes, trabeculation, and tip orientation were assessed by three readers.
Main Results:
- Excellent intra-observer and interobserver reproducibility for LAA and LA volume measurements (ICCs > 0.9).
- Volume measurements were comparable between 2CV and TV orientations.
- Poor to fair reproducibility for morphological classification and specific features (Kappa values < 0.4).
Conclusions:
- LAA and LA volume measurements by cCT are highly reproducible and reliable.
- Visual assessment of LAA morphology demonstrates significant interreader variability, indicating limited reliability.
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.
