Open Access Highly Accessed Open Badges Research

Quantification of left ventricular trabeculae using fractal analysis

Gabriella Captur12, Vivek Muthurangu23, Christopher Cook1, Andrew S Flett12, Robert Wilson4, Andrea Barison15, Daniel M Sado12, Sarah Anderson1, William J McKenna12, Timothy J Mohun4, Perry M Elliott12 and James C Moon12*

Author Affiliations

1 Division of Cardiovascular Imaging, The Heart Hospital, part of University College London NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK

2 UCL Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK

3 UCL Centre for Cardiovascular Imaging and Great Ormond Street Hospital for Children (GOSH), London, WC1N 3JH, UK

4 Department of Developmental Biology, MRC National Institute for Medical Research, The Ridgeway Mill Hill, London, NW7 1AA, UK

5 Scuola Superiore Sant’Anna, Pisa and Fondazione “G. Monasterio” CNR - Regione Toscana, Pisa, 56124, Italy

For all author emails, please log on.

Journal of Cardiovascular Magnetic Resonance 2013, 15:36  doi:10.1186/1532-429X-15-36

Published: 10 May 2013



Left ventricular noncompaction (LVNC) is a myocardial disorder characterized by excessive left ventricular (LV) trabeculae. Current methods for quantification of LV trabeculae have limitations. The aim of this study is to describe a novel technique for quantifying LV trabeculation using cardiovascular magnetic resonance (CMR) and fractal geometry. Observing that trabeculae appear complex and irregular, we hypothesize that measuring the fractal dimension (FD) of the endocardial border provides a quantitative parameter that can be used to distinguish normal from abnormal trabecular patterns.


Fractal analysis is a method of quantifying complex geometric patterns in biological structures. The resulting FD is a unitless measure index of how completely the object fills space. FD increases with increased structural complexity. LV FD was measured using a box-counting method on CMR short-axis cine stacks. Three groups were studied: LVNC (defined by Jenni criteria), n=30(age 41±13; men, 16); healthy whites, n=75(age, 46±16; men, 36); healthy blacks, n=30(age, 40±11; men, 15).


In healthy volunteers FD varied in a characteristic pattern from base to apex along the LV. This pattern was altered in LVNC where apical FD were abnormally elevated. In healthy volunteers, blacks had higher FD than whites in the apical third of the LV (maximal apical FD: 1.253±0.005 vs. 1.235±0.004, p<0.01) (mean±s.e.m.). Comparing LVNC with healthy volunteers, maximal apical FD was higher in LVNC (1.392±0.010, p<0.00001). The fractal method was more accurate and reproducible (ICC, 0.97 and 0.96 for intra and inter-observer readings) than two other CMR criteria for LVNC (Petersen and Jacquier).


FD is higher in LVNC patients compared to healthy volunteers and is higher in healthy blacks than in whites. Fractal analysis provides a quantitative measure of trabeculation and has high reproducibility and accuracy for LVNC diagnosis when compared to current CMR criteria.

Cardiomyopathy; Heart failure; Trabeculation