Pericardial adipose tissue radiomics combined with conventional MRI scores improved MACE risk stratification in end-stage renal disease patients (external validation C-index: 0.737 vs. 0.774).
Does the addition of pericardial adipose tissue radiomics to conventional MRI risk scores improve risk stratification for MACE in patients with end-stage renal disease?
Cardiac MRI cine-based pericardial adipose tissue radiomics features improve risk stratification for MACE in ESRD patients compared to conventional clinical and MRI parameters.
ABSTRACT Background While pericardial adipose tissue (PEAT) volume is linked to cardiac risk, the prognostic value of its radiomic features for major adverse cardiac events (MACE: a composite of cardiac death, myocardial infarction, heart failure hospitalization, or stroke) in end‐stage renal disease (ESRD) patients is unknown. Purpose To evaluate the association of PEAT radiomics with MACE in patients with ESRD. Study Type Retrospective. Population Two hundred forty‐eight ESRD patients (160 males) from three centers were included and divided into development (198 patients) and validation cohorts (50 patients) by centers. Field Strength/Sequence 3.0 T/cine imaging, T2 and T2* mappings, all gradient echo. Assessment A triple‐stage Unet model (3SUnet) was used for the segmentation of PEAT in cine images. Myocardial T2 and T2* values were extracted from native T2 and T2* images. Demographic and laboratory data were collected within 1 week of the MRI scan. Participants were followed up from the MRI scanning every 2 weeks until July 2023 until MACE occurred. Statistical Tests Principal component analysis (PCA) was used to reduce radiomic features to principal radiomics (PrPEAT‐rads). Cox regression analyses were used to investigate the prognostic value of extracted PrPEAT‐rads. p ‐value ≤ 0.05 was considered statistically significant. Results During a median follow‐up time of 35.6 months, 63 patients (25.4% of 248; 15 in the external validation cohort) experienced MACE. The combined use of selected PrPEAT‐rads with conventional MRI risk scores significantly improved risk stratification of MACE in both the internal (C‐index: 0.715 vs. 0.768; integrated Brier score IBS: 0.095 vs. 0.090) and the external validation cohort (C‐index: 0.737 vs. 0.774; IBS: 0.130 vs. 0.070). PrPEAT‐rad1 was a significant independent factor associated with MACE after adjusting for both clinical (HR: 0.937) and MRI (HR: 0.916) covariates. Data Conclusion The cardiac MRI cine‐based PEAT radiomics features in ESRD patients demonstrated a stronger association with MACE compared to conventional clinical and MRI parameters. Evidence Level 3. Stage of Technology Efficacy Stage 2.
Zhang et al. (2026) studied this question. Pericardial adipose tissue radiomics combined with conventional MRI scores improved MACE risk stratification in end-stage renal disease patients (external validation C-index: 0.737 vs. 0.774).