Key result
Higher perivascular fat density is linked to ~20% higher odds of recent cerebrovascular events.
Why the study?
The association between perivascular fat density and carotid plaque characteristics, as well as the discriminative ability of perivascular fat density and lipid-rich necrotic core plaques for symptomatic cerebrovascular events, required investigation.
Does combining perivascular fat density and lipid-rich necrotic core plaque assessment on black-blood CT with stenosis severity improve the discrimination of recent symptomatic cerebrovascular events (acute ischemic stroke or TIA) in patients with unilateral carotid atherosclerosis?
Cross-Sectional (n=119)
Blinded image evaluation
No
Does combining perivascular fat density and lipid-rich necrotic core plaque assessment on black-blood CT with stenosis severity improve the discrimination of recent symptomatic cerebrovascular events (acute ischemic stroke or TIA) in patients with unilateral carotid atherosclerosis?
Perivascular fat density measured on CT is positively correlated with vulnerable carotid plaque features, and combining it with lipid-rich necrotic core assessment and stenosis severity significantly improves the discrimination of recent symptomatic cerebrovascular events compared to evaluating stenosis alone.
Perivascular fat density was associated with symptomatic events; leaves open its role as a vulnerability marker pending prospective validation.
Objective The aim of this study was to investigate the association between perivascular fat density (PFD) and carotid plaque characteristics and to evaluate the discriminative ability of PFD and lipid-rich necrotic core plaques in relation to symptomatic status of cerebrovascular events. Methods A retrospective cross-sectional analysis was conducted in 119 patients with unilateral carotid atherosclerosis. Patients were classified into symptomatic and asymptomatic groups based on the occurrence of acute ischemic stroke or transient ischemic attack within the preceding two weeks. Differences in plaque characteristics, PFD, lipid-rich core plaques, and geometric parameters between the two groups were compared using non-parametric statistical tests. Spearman rank correlation analysis was used to evaluate the association between PFD and plaque characteristics. Multivariable logistic regression analysis was performed to identify risk factors and develop discriminative models. Internal validation was performed using bootstrap-derived optimism-corrected AUC. Results Statistically significant differences in plaque characteristics, PFD, lipid-rich necrotic core plaques, and geometric parameters were observed between the symptomatic and asymptomatic groups ( p < 0.001). PFD was positively correlated with plaque characteristics ( p < 0.001). PFD, degree of stenosis, and the presence of lipid-rich core plaques were identified as independent correlates of cerebrovascular events. Receiver operating characteristic curve analysis demonstrated that the combined model improved the area under the curve from 0.885 for the stenosis-only model to 0.972. Calibration analysis demonstrated good agreement between model-estimated probabilities and observed outcomes, and decision curve analysis indicated greater net clinical benefit for the combined model than for the stenosis-only model. Conclusion PFD is positively associated with carotid plaque characteristics and may serve as an imaging marker for assessing the perivascular inflammatory state. Combining PFD with stenosis severity and LRNC plaques demonstrated high discriminative value in assessing the symptomatic status of recent cerebrovascular events.
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Yue et al. (2026) conducted a cross-sectional in Unilateral carotid atherosclerosis (n=119). Maximum perivascular fat density (PFDmax) vs. Asymptomatic unilateral carotid atherosclerosis was evaluated on Recent symptomatic cerebrovascular events (acute ischemic stroke or TIA within the preceding two weeks) (OR 1.196, 95% CI 1.045-1.369, p=0.009). Maximum perivascular fat density was independently associated with recent symptomatic cerebrovascular events (OR 1.196) and improved discrimination to an AUC of 0.972 when combined with stenosis and LRNC.
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