Cardiac segmentation model

Changed by Craig Hacking, 18 Nov 2016

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~~17 segment model~~ ~~recommended by~~The American Heart Association (AHA) ~~divides~~has published the nomenclature and segmentation of the left ~~ventricle~~ventricular myocardium (the cardiac segmentation model), now widely used for the description of disease-affected myocardial territories and wall ~~into~~function. There are 17 segments ~~to study~~that have a reasonably consistent vascular supply from one of the ~~wall function~~three main coronary arteries (RCA, LAD and ~~myocardial perfusion~~LCx), but significant anatomic variant does exist. ~~This~~ This standard segmentation can be used in cardiac nuclear tests, computed tomography, magnetic resonance imaging, echocardiography and coronary angiography. Having a standard model makes intra- and inter-modality comparison possible.

Segments

~~Basal~~

In the long axis the left ventricle is divided into equal thirds named the basal, mid and apical thirds. The tip of the apex forms a separate final segment. When these thirds are viewed in short axis they form rings which can be further divided into equal sectors:

~~segment~~The basal third has six 60^o sectors:
- Basal anterior (segment 1~~: basal anterior~~)
- ~~segment~~Basal anteroseptal (segment 2~~: basal anteroseptal~~)
- ~~segment~~Basal inferoseptal (segment 3~~: basal inferoseptal~~)
- ~~segment~~Basal inferior (segment 4~~: basal inferior~~)
- ~~segment~~Basal inferolateral (segment 5~~: basal inferolateral~~)
- ~~segment~~Basal anterolateral (segment 6~~: basal anterolateral~~)
~~Mid-cavity~~
The mid third has six 60^o sectors:
- ~~segment~~Mid anterior (segment 7~~: mid anterior~~)
- ~~segment~~Mid anteroseptal (segment 8~~: mid anteroseptal~~)
- ~~segment~~Mid inferoseptal (segment 9~~: mid inferoseptal~~)
- ~~segment~~Mid inferior (segment 10~~: mid inferior~~)
- ~~segment~~Mid inferolateral (segment 11~~: mid inferolateral~~)
- ~~segment~~Mid anterolateral (segment 12~~: mid anterolateral~~)
~~Apical~~
The apical third has four 90^o sectors:
- ~~segment~~Apical anterior (segment 13~~: apical anterior~~)
- ~~segment~~Apical septal (segment 14~~: apical septal~~)
- ~~segment~~Apical inferior (segment 15~~: apical inferior~~)
- ~~segment~~Apical lateral (segment 16~~: apical lateral~~)
Finally the tip of the ventricular apex is its own segment.
- Apex (segment 17~~: apex~~)

Coronary artery territories

Left anterior descending
LAD supplies

segments~~: 1~~ 1, 2, 7, 8, 13, 14, and 17

Right coronary artery

RCA supplies

segments~~: 3~~ 3, 4, 9, 10, and 15

Left circumflex

LCx supplies

segments~~: 5~~ 5, 6, 11, 12, and 16

Echocardiography

The inability to visualise the whole chamber often necessitates utilization of anatomical landmarks to delineate the thirds:

basal: mitral annulus to the tips of the papillary muscles in end-diastole
mid: along the length of the papillary muscles  
apical: below the papillary muscles to the apex

-<p><strong>17 segment model</strong> recommended by American Heart Association (AHA) divides the left ventricle wall into 17 segments to study the wall function and myocardial perfusion. This standard segmentation can be used in cardiac nuclear tests, computed tomography, magnetic resonance imaging, and coronary angiography. Having a standard model makes intra- and inter-modality comparison possible.</p><h4>Segments</h4><h5>Basal</h5><ul>
~~-<li>segment 1: basal anterior</li>~~
~~-<li>segment 2: basal anteroseptal</li>~~
~~-<li>segment 3: basal inferoseptal</li>~~
~~-<li>segment 4: basal inferior</li>~~
~~-<li>segment 5: basal inferolateral</li>~~
~~-<li>segment 6: basal anterolateral</li>~~
~~-</ul><h5>Mid-cavity</h5><ul>~~
~~-<li>segment 7: mid anterior</li>~~
~~-<li>segment 8: mid anteroseptal</li>~~
~~-<li>segment 9: mid inferoseptal</li>~~
~~-<li>segment 10: mid inferior</li>~~
~~-<li>segment 11: mid inferolateral</li>~~
~~-<li>segment 12: mid anterolateral</li>~~
~~-</ul><h5>Apical</h5><ul>~~
~~-<li>segment 13: apical anterior</li>~~
~~-<li>segment 14: apical septal</li>~~
~~-<li>segment 15: apical inferior</li>~~
~~-<li>segment 16: apical lateral</li>~~
~~-<li>segment 17: apex</li>~~
-</ul><h4>Coronary artery territories</h4><h5>Left anterior descending supplies</h5><ul><li>segments: 1, 2, 7, 8, 13, 14, 17</li></ul><h5>Right coronary artery supplies</h5><ul><li>segments: 3, 4, 9, 10, 15</li></ul><h5>Left circumflex supplies</h5><ul><li>segments: 5, 6, 11, 12, 16</li></ul>
+<p>The American Heart Association (AHA) has published the nomenclature and segmentation of the left ventricular myocardium (the <strong>cardiac segmentation model</strong>), now widely used for the description of disease-affected myocardial territories and wall function. There are 17 segments that have a reasonably consistent vascular supply from one of the three main coronary arteries (RCA, LAD and LCx), but significant anatomic variant does exist. This standard segmentation can be used in cardiac nuclear tests, computed tomography, magnetic resonance imaging, echocardiography and coronary angiography. Having a standard model makes intra- and inter-modality comparison possible.</p><h4>Segments</h4><p>In the long axis the left ventricle is divided into equal thirds named the <strong>basal</strong>, <strong>mid </strong>and<strong> apical</strong> thirds. The tip of the apex forms a separate final segment. When these thirds are viewed in short axis they form rings which can be further divided into equal sectors:</p><ul>
+<li>The <strong>basal third </strong>has six 60<sup>o</sup> sectors:<ul>
+<li>Basal anterior (segment 1)</li>
+<li>Basal anteroseptal (segment 2)</li>
+<li>Basal inferoseptal (segment 3)</li>
+<li>Basal inferior (segment 4)</li>
+<li>Basal inferolateral (segment 5)</li>
+<li>Basal anterolateral (segment 6)</li>
+</ul>
+</li>
+<li>The <strong>mid third</strong> has six 60<sup>o</sup> sectors:<ul>
+<li>Mid anterior (segment 7)</li>
+<li>Mid anteroseptal (segment 8)</li>
+<li>Mid inferoseptal (segment 9)</li>
+<li>Mid inferior (segment 10)</li>
+<li>Mid inferolateral (segment 11)</li>
+<li>Mid anterolateral (segment 12)</li>
+</ul>
+</li>
+<li>The <strong>apical third</strong> has four 90<sup>o</sup> sectors:<ul>
+<li>Apical anterior (segment 13)</li>
+<li>Apical septal (segment 14)</li>
+<li>Apical inferior (segment 15)</li>
+<li>Apical lateral (segment 16)</li>
+</ul>
+</li>
+<li>Finally the tip of the ventricular apex is its own segment.<ul><li>Apex (segment 17)</li></ul>
+</li>
+</ul><h4>Coronary artery territories</h4><ul>
+<li>
+<a href="/articles/lad">LAD</a> supplies segments 1, 2, 7, 8, 13, 14 and 17</li>
+<li>
+<a href="/articles/right-coronary-artery">RCA</a> supplies segments 3, 4, 9, 10 and 15</li>
+<li>
+<a href="/articles/circumflex-artery">LCx</a> supplies segments 5, 6, 11, 12 and 16</li>
+</ul><h4>Echocardiography</h4><p>The inability to visualise the whole chamber often necessitates utilization of anatomical landmarks to delineate the thirds:</p><ul>
+<li>basal: mitral annulus to the tips of the papillary muscles in end-diastole</li>
+<li>mid: along the length of the papillary muscles  </li>
+<li>apical: below the papillary muscles to the apex  </li>
+</ul><p></p>

References changed:

4. Butler P, Mitchell A, Healy JC. Applied Radiological Anatomy. Cambridge University Press. (2012) ISBN:0521766664. <a href="http://books.google.com/books?vid=ISBN0521766664">Read it at Google Books</a> - <a href="http://www.amazon.com/gp/product/0521766664">Find it at Amazon</a><span class="ref_v3"></span>

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Cardiac segmentation model