Key result
Non-contrast CT pericoronary fat radiomics predicts MACE with an AUC of ~0.83, comparable to CCTA.
Why the study?
Pericoronary adipose tissue features from coronary CTA are associated with cardiovascular risk but may be confounded by iodine, and the feasibility of using non-contrast CT calcium score images for PCAT analysis was unknown.
Does pericoronary adipose tissue feature analysis from non-contrast CT calcium score images predict MACE comparably to coronary CTA in patients with suspected CAD?
Observational (n=83)
No
Does pericoronary adipose tissue feature analysis from non-contrast CT calcium score images predict MACE comparably to coronary CTA in patients with suspected CAD?
Absolute Event Rate: 0.83% vs 0.77%
Pericoronary adipose tissue features extracted from non-contrast CT calcium score images can predict major adverse cardiovascular events with performance comparable to contrast-enhanced coronary CTA, avoiding iodine-related confounders.
We investigated the feasibility and advantages of using non-contrast CT calcium score (CTCS) images to assess pericoronary adipose tissue (PCAT) and its association with major adverse cardiovascular events (MACE). PCAT features from coronary CTA (CCTA) have been shown to be associated with cardiovascular risk but are potentially confounded by iodine. If PCAT in CTCS images can be similarly analyzed, it would avoid this issue and enable its inclusion in formal risk assessment from readily available, low-cost CTCS images. To identify coronaries in CTCS images that have subtle visual evidence of vessels, we registered CTCS with paired CCTA images having coronary labels. We developed a novel axial-disk method giving regions for analyzing PCAT features in three main coronary arteries. We analyzed novel hand-crafted and radiomic features using univariate and multivariate logistic regression prediction of MACE and compared results against those from CCTA. Registration accuracy was sufficient to enable the identification of PCAT regions in CTCS images. Motion or beam hardening artifacts were often present in high-contrast CCTA but not CTCS. Mean HU and volume were increased in both CTCS and CCTA for MACE group. There were significant positive correlations between some CTCS and CCTA features, suggesting that similar characteristics were obtained. Using hand-crafted/radiomics from CTCS and CCTA, AUCs were 0.82/0.79 and 0.83/0.77 respectively, while Agatston gave AUC=0.73. Preliminarily, PCAT features can be assessed from three main coronary arteries in non-contrast CTCS images with performance characteristics that are at the very least comparable to CCTA.
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Song et al. (2024) conducted an observational in Suspected coronary artery disease (n=83). Pericoronary adipose tissue feature analysis in CT calcium score images vs. Coronary CTA and Agatston score was evaluated on Prediction of major adverse cardiovascular events (MACE) measured by Area Under the Curve (AUC). Pericoronary adipose tissue radiomic features assessed from non-contrast CT calcium score images predicted major adverse cardiovascular events with an AUC of 0.83, comparable to coronary CTA (AUC 0.77).
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