Focal pericoronary adipose tissue attenuation is related to plaque presence, plaque type, and stenosis severity in coronary CTA
Runlei Ma, Marly van Assen, Daan Ties, Gert Jan Pelgrim, Randy van Dijk, Grigory Sidorenkov, Peter M. A. van Ooijen, Pim van der Harst, Rozemarijn Vliegenthart
Abstract
Abstract Objectives To investigate the association of pericoronary adipose tissue mean attenuation (PCAT MA ) with coronary artery disease (CAD) characteristics on coronary computed tomography angiography (CCTA). Methods We retrospectively investigated 165 symptomatic patients who underwent third-generation dual-source CCTA at 70kVp: 93 with and 72 without CAD (204 arteries with plaque, 291 without plaque). CCTA was evaluated for presence and characteristics of CAD per artery. PCAT MA was measured proximally and across the most severe stenosis. Patient-level, proximal PCAT MA was defined as the mean of the proximal PCAT MA of the three main coronary arteries. Analyses were performed on patient and vessel level. Results Mean proximal PCAT MA was −96.2 ± 7.1 HU and −95.6 ± 7.8HU for patients with and without CAD ( p = 0.644). In arteries with plaque, proximal and lesion-specific PCAT MA was similar (−96.1 ± 9.6 HU, −95.9 ± 11.2 HU, p = 0.608). Lesion-specific PCAT MA of arteries with plaque (−94.7 HU) differed from proximal PCAT MA of arteries without plaque (−97.2 HU, p = 0.015). Minimal stenosis showed higher lesion-specific PCAT MA (−94.0 HU) than severe stenosis (−98.5 HU, p = 0.030). Lesion-specific PCAT MA of non-calcified, mixed, and calcified plaque was −96.5 HU, −94.6 HU, and −89.9 HU ( p = 0.004). Vessel-based total plaque, lipid-rich necrotic core, and calcified plaque burden showed a very weak to moderate correlation with proximal PCAT MA . Conclusions Lesion-specific PCAT MA was higher in arteries with plaque than proximal PCAT MA in arteries without plaque. Lesion-specific PCAT MA was higher in non-calcified and mixed plaques compared to calcified plaques, and in minimal stenosis compared to severe; proximal PCAT MA did not show these relationships. This suggests that lesion-specific PCAT MA is related to plaque development and vulnerability. Key Points • In symptomatic patients undergoing CCTA at 70 kVp, PCAT MA was higher in coronary arteries with plaque than those without plaque. • PCAT MA was higher for non-calcified and mixed plaques compared to calcified plaques, and for minimal stenosis compared to severe stenosis. • In contrast to PCAT MA measurement of the proximal vessels, lesion-specific PCAT MA showed clear relationships with plaque presence and stenosis degree.