Effect of imaging parameters and clinical characteristics on pericoronary adipose tissue attenuation in patients without coronary plaque

Q: What are the key findings of this study?

In patients without coronary plaque, pericoronary adipose tissue attenuation was significantly influenced by imaging parameters such as tube voltage (β=4.9 to 8.1 for 120 vs 100 kVp) as well as clinical characteristics.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Suspected coronary artery disease without coronary plaque (n=196). Intervention: Imaging parameters (e.g., tube voltage 120 vs 100 kVp) and clinical characteristics vs. 100 kVp and reference clinical subgroups. Primary outcome: Fat attenuation index (FAI) of pericoronary adipose tissue (β=4.9 to 8.1 for 120 vs 100 kVp, p=<0.001).

Q: What does this research mean for the field?

In patients without coronary plaque, pericoronary adipose tissue attenuation is significantly influenced by CCTA imaging parameters, such as tube voltage and reconstruction algorithm, as well as patient clinical characteristics. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate how coronary computed tomography angiography acquisition parameters and patient clinical characteristics influence the pericoronary fat attenuation index in individuals without coronary plaque.

Yan Chen; Jianbin Zhu; Mingjun Lu; Zhibo Wen

doi:10.21037/qims-2026-0484

August 24, 2026Quantitative Imaging in Medicine and SurgeryOpen Access

Effect of imaging parameters and clinical characteristics on pericoronary adipose tissue attenuation in patients without coronary plaque

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Key result

Higher tube voltage on CCTA is associated with significantly increased pericoronary adipose tissue attenuation.

β=+4.9 to 8.1 for 120 vs 100 kVp
P<0.001
n=196

Figures

Why the study?

Pericoronary adipose tissue attenuation is influenced by multiple confounders, and the impact of CCTA imaging parameters and clinical characteristics on fat attenuation index requires investigation.

Do imaging parameters and clinical characteristics independently influence the fat attenuation index (FAI) of pericoronary adipose tissue in patients without coronary plaque?

Key Points

To evaluate how coronary computed tomography angiography acquisition parameters and patient clinical characteristics influence the pericoronary fat attenuation index in individuals without coronary plaque.
Retrospective evaluation of 196 subjects without coronary plaque (mean age 55.4±9.5 years; 81 males) undergoing CCTA at 100 or 120 kVp with two distinct reconstruction algorithms.
PCAT attenuation was quantified across proximal 40-mm segments and individual 10-mm segments of the RCA, LAD, and LCX, with interobserver agreement assessed via ICC.
Multivariable linear regression identified independent imaging and clinical variables associated with FAI values across coronary segments.
Higher tube voltage (120 vs. 100 kVp) independently predicted increased FAI across nearly all coronary segments (β=4.9 to 8.1, all P<0.001), while iterative model reconstruction yielded lower FAI values than hybrid iterative reconstruction (β=−3.0 to −2.2, P<0.05).
Smoking was positively associated with FAI in multiple vessels (β=4.1 to 6.5, P=0.009 to 0.042), whereas higher BMI (β=−3.4 to −2.4) and dyslipidemia (β=−3.9 to −2.5, P=0.008 to 0.045) were negatively associated with FAI.
Vessel attenuation, age, hypertension, and family history of coronary artery disease showed no significant independent associations with FAI (all P>0.05).

Study Design

Type

Observational (n=196)

Blinding

Single-blind

Multicenter

No

Structured PICO

Do imaging parameters and clinical characteristics independently influence the fat attenuation index (FAI) of pericoronary adipose tissue in patients without coronary plaque?

P

Population

196 adults (mean age 55.4 years, 58.7% female) without evidence of coronary plaque on CCTA evaluated for factors influencing pericoronary adipose tissue attenuation.

E

Exposure

Coronary computed tomography angiography (CCTA) evaluated for varied imaging parameters including 100 or 120 kVp tube voltage and reconstruction methods (iDose4 with Xres Standard vs. Iterative Model Reconstruction with Cardiac Routine).

C

Comparator

Comparisons across different imaging parameters (e.g., 100 kVp vs. 120 kVp) and clinical characteristics within the same cohort.

O

Outcome

Fat attenuation index (FAI) of pericoronary adipose tissue (PCAT), calculated as the mean CT attenuation value (-190 to -30 HU), evaluated via a proximal 40-mm segment and a 10-mm segment method.surrogate

Main Result

Effect estimate: β=4.9 to 8.1 for 120 vs 100 kVp

p-value: p=<0.001

Limitations

Coronary artery calcium score was not assessed, so some small calcifications might have been missed
Cannot completely exclude the possibility of PCAT inflammation in some patients without CAD
Heart rate and tube current were not accounted for as potential confounders
Placement of the 10-mm segment may be subject to some variability
Single-center retrospective study design
Diagnosis of no CAD was based on CCTA without a coronary artery calcium score, potentially missing small calcifications
Other potential confounders like heart rate and tube current were not accounted for
Placement of the 10-mm segment may still be subject to some variability despite excellent interobserver agreement
Single-center study design

Implication

Pericoronary adipose tissue attenuation is significantly altered by CCTA imaging parameters like tube voltage and clinical characteristics, underscoring the need to account for these confounders when using FAI to measure coronary inflammation.

Abstract

Background: Pericoronary adipose tissue (PCAT) attenuation serves as a marker of coronary inflammation. However, numerous confounders may affect PCAT attenuation. This study aimed to investigate the influence of coronary computed tomography angiography (CCTA) imaging parameters and clinical characteristics on the fat attenuation index (FAI) of PCAT. Methods: One hundred and ninety-six subjects [mean age ± standard deviation (SD), 55.4±9.5 years; 81 males] who underwent CCTA and had no coronary plaque were included in this retrospective study. Images were scanned at 100 or 120 kVp and reconstructed using two methods. PCAT attenuation was assessed using two measurement approaches: a proximal 40-mm segment of each coronary artery and a 10-mm segment in each coronary artery segment. The intraclass correlation coefficient (ICC) was used to assess interobserver agreement for FAI measurements. Linear regression analyses were performed to identify independent factors associated with FAI. Results: (β=-3.9 to -2.5, all P<0.05). Other factors, including vessel attenuation, age, hypertension, and family history of coronary artery disease (CAD), showed no significant associations. Conclusions: In patients without coronary plaque, PCAT attenuation depends on imaging parameters and clinical characteristics, underscoring the importance of considering both imaging and clinical factors when interpreting FAI measurements.

Discussion

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Cite This Study

Chen et al. (2026) conducted an observational in Suspected coronary artery disease without coronary plaque (n=196). Imaging parameters (e.g., tube voltage 120 vs 100 kVp) and clinical characteristics vs. 100 kVp and reference clinical subgroups was evaluated on Fat attenuation index (FAI) of pericoronary adipose tissue (β=4.9 to 8.1 for 120 vs 100 kVp, p=<0.001). In patients without coronary plaque, pericoronary adipose tissue attenuation was significantly influenced by imaging parameters such as tube voltage (β=4.9 to 8.1 for 120 vs 100 kVp) as well as clinical characteristics.

synapsesocial.com/papers/6ad0fcc53afa093ea9acffcc https://doi.org/10.21037/qims-2026-0484

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Effect of imaging parameters and clinical characteristics on pericoronary adipose tissue attenuation in patients without coronary plaque

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Effect of imaging parameters and clinical characteristics on pericoronary adipose tissue attenuation in patients without coronary plaque

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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