Comparison of right atrial volume measurements using single-plane area-length and stack-of-short-axis methods: A 3.0 T cardiac magnetic resonance study

Abstract Purpose The stack-of-short-axis volumes (SAX) summation and single-plane area-length (AL) methods are established approaches for right atrial (RA) volume quantification in cardiovascular magnetic resonance (CMR) imaging. However, data regarding the reliability and agreement between these me...

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Main Authors: Nabhat Noparatkailas, Ankavipar Saprungruang, Piyanun Sanguanwong, Angkana Sunthornram, Yongkasem Vorasettakarnkij, Monravee Tumkosit, Pairoj Chattranukulchai, Nonthikorn Theerasuwipakorn
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Medical Imaging
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Online Access:https://doi.org/10.1186/s12880-025-01708-y
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author Nabhat Noparatkailas
Ankavipar Saprungruang
Piyanun Sanguanwong
Angkana Sunthornram
Yongkasem Vorasettakarnkij
Monravee Tumkosit
Pairoj Chattranukulchai
Nonthikorn Theerasuwipakorn
author_facet Nabhat Noparatkailas
Ankavipar Saprungruang
Piyanun Sanguanwong
Angkana Sunthornram
Yongkasem Vorasettakarnkij
Monravee Tumkosit
Pairoj Chattranukulchai
Nonthikorn Theerasuwipakorn
author_sort Nabhat Noparatkailas
collection DOAJ
description Abstract Purpose The stack-of-short-axis volumes (SAX) summation and single-plane area-length (AL) methods are established approaches for right atrial (RA) volume quantification in cardiovascular magnetic resonance (CMR) imaging. However, data regarding the reliability and agreement between these methods are limited. Furthermore, there is no validation on whether to include the right atrial appendage (RAA) in the analysis. This study aims to evaluate the reliability of the single-plane AL and SAX methods for measuring RA volumes and to assess the agreement between these two approaches. Methods CMR (3.0T, Siemens) data from 40 healthy volunteers were analyzed to quantify RA volumes, both including and excluding RAA volume, using the SAX and single-plane (4-chamber view) AL methods. Results The mean age of 40 participants was 33.6 ± 6.1 years (50% male). RA volumes measured by the SAX method were significantly larger than those obtained by the single-plane AL method (maximum RA volume including RAA: 84.9 ± 22.9 vs. 63.7 ± 16.0 ml, p-value < 0.001; minimum RA volume including RAA: 45.3 ± 15.9 vs. 34.7 ± 12.2 ml, p-value < 0.001). RA ejection fraction (RAEF) was the only parameter that showed no statistical difference between the two methods. Bland-Altman plots demonstrated poor agreement between the techniques, with substantial biases and wide limits of agreement. Both methods exhibited excellent reproducibility when the RAA volume was included (ICC = 0.89–0.96). However, reproducibility was reduced when the RAA volume was excluded, particularly in terms of inter-observer agreement (ICC = 0.73–0.96). Conclusions The single-plane AL method underestimates RA volumes compared to the SAX method, and the poor agreement between the two techniques suggests they should not be used interchangeably. RA volume measurements should be interpreted using method-specific reference values. Additionally, including the RAA in RA volume quantification—regardless of the method—may improve measurement reproducibility.
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spelling doaj-art-db75331e00d84cdab4214e8cd473d34c2025-08-20T02:25:13ZengBMCBMC Medical Imaging1471-23422025-05-012511910.1186/s12880-025-01708-yComparison of right atrial volume measurements using single-plane area-length and stack-of-short-axis methods: A 3.0 T cardiac magnetic resonance studyNabhat Noparatkailas0Ankavipar Saprungruang1Piyanun Sanguanwong2Angkana Sunthornram3Yongkasem Vorasettakarnkij4Monravee Tumkosit5Pairoj Chattranukulchai6Nonthikorn Theerasuwipakorn7Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityDivision of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial HospitalDepartment of Medicine, Ananda Mahidol HospitalDepartment of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial HospitalDivision of Hospital and Ambulatory Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial HospitalDepartment of Radiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial HospitalCardiac Center, King Chulalongkorn Memorial HospitalCardiac Center, King Chulalongkorn Memorial HospitalAbstract Purpose The stack-of-short-axis volumes (SAX) summation and single-plane area-length (AL) methods are established approaches for right atrial (RA) volume quantification in cardiovascular magnetic resonance (CMR) imaging. However, data regarding the reliability and agreement between these methods are limited. Furthermore, there is no validation on whether to include the right atrial appendage (RAA) in the analysis. This study aims to evaluate the reliability of the single-plane AL and SAX methods for measuring RA volumes and to assess the agreement between these two approaches. Methods CMR (3.0T, Siemens) data from 40 healthy volunteers were analyzed to quantify RA volumes, both including and excluding RAA volume, using the SAX and single-plane (4-chamber view) AL methods. Results The mean age of 40 participants was 33.6 ± 6.1 years (50% male). RA volumes measured by the SAX method were significantly larger than those obtained by the single-plane AL method (maximum RA volume including RAA: 84.9 ± 22.9 vs. 63.7 ± 16.0 ml, p-value < 0.001; minimum RA volume including RAA: 45.3 ± 15.9 vs. 34.7 ± 12.2 ml, p-value < 0.001). RA ejection fraction (RAEF) was the only parameter that showed no statistical difference between the two methods. Bland-Altman plots demonstrated poor agreement between the techniques, with substantial biases and wide limits of agreement. Both methods exhibited excellent reproducibility when the RAA volume was included (ICC = 0.89–0.96). However, reproducibility was reduced when the RAA volume was excluded, particularly in terms of inter-observer agreement (ICC = 0.73–0.96). Conclusions The single-plane AL method underestimates RA volumes compared to the SAX method, and the poor agreement between the two techniques suggests they should not be used interchangeably. RA volume measurements should be interpreted using method-specific reference values. Additionally, including the RAA in RA volume quantification—regardless of the method—may improve measurement reproducibility.https://doi.org/10.1186/s12880-025-01708-yCardiac magnetic resonanceRight atrium volumeSingle-plane area-lengthStack-of-short-axis
spellingShingle Nabhat Noparatkailas
Ankavipar Saprungruang
Piyanun Sanguanwong
Angkana Sunthornram
Yongkasem Vorasettakarnkij
Monravee Tumkosit
Pairoj Chattranukulchai
Nonthikorn Theerasuwipakorn
Comparison of right atrial volume measurements using single-plane area-length and stack-of-short-axis methods: A 3.0 T cardiac magnetic resonance study
BMC Medical Imaging
Cardiac magnetic resonance
Right atrium volume
Single-plane area-length
Stack-of-short-axis
title Comparison of right atrial volume measurements using single-plane area-length and stack-of-short-axis methods: A 3.0 T cardiac magnetic resonance study
title_full Comparison of right atrial volume measurements using single-plane area-length and stack-of-short-axis methods: A 3.0 T cardiac magnetic resonance study
title_fullStr Comparison of right atrial volume measurements using single-plane area-length and stack-of-short-axis methods: A 3.0 T cardiac magnetic resonance study
title_full_unstemmed Comparison of right atrial volume measurements using single-plane area-length and stack-of-short-axis methods: A 3.0 T cardiac magnetic resonance study
title_short Comparison of right atrial volume measurements using single-plane area-length and stack-of-short-axis methods: A 3.0 T cardiac magnetic resonance study
title_sort comparison of right atrial volume measurements using single plane area length and stack of short axis methods a 3 0 t cardiac magnetic resonance study
topic Cardiac magnetic resonance
Right atrium volume
Single-plane area-length
Stack-of-short-axis
url https://doi.org/10.1186/s12880-025-01708-y
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