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Pan Y, Gao Y, Wang Z, Dou Y, Sun X, Yang Z, Pan S, Jia C. Effects of low-tube voltage coronary CT angiography on plaque and pericoronary fat assessment: intraindividual comparison. Eur Radiol 2024; 34:5713-5723. [PMID: 38466391 DOI: 10.1007/s00330-024-10648-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES To investigate the effects of low tube voltage on coronary plaques and pericoronary fat assessment, and to compare their extent among various levels of low voltage. MATERIALS AND METHODS Patients were recommended for high-pitch low-tube voltage coronary computed tomography angiography (CCTA), and they were included if they had poor image quality and were referred to a conventional CCTA. The patients were classified into a low-voltage group (with 70-kV, 80-kV, and 90-kV subgroups) and a conventional group (100/120 kV). Their total plaque and subcomponent volumes and pericoronary fat attenuation index (FAI) were measured. RESULTS A total of 1002 image slices (from 65 patients and 74 plaques) were included, including 21, 31, 13, 4, and 61 patients in the 70-kV, 80-kV, 90-kV, 100-kV, and 120-kV groups respectively. The CT values of noncalcified plaques in the conventional and low-voltage groups were 54.6 ± 21.3 HU and 31.5 ± 22.6 HU, respectively (p < 0.05). Compared with the conventional group, the necrotic core and calcification volume were increased, and the fibrolipid volume, periplaque, and right coronary artery FAI were decreased in the low-voltage group and its subgroups (p < 0.001). The magnitude of changes in fibrous and calcification volumes increased in the 70-kV subgroup compared with that in the 90-kV subgroup (p < 0.05). CONCLUSION Low tube voltages, particularly of 70 kV, have a significant effect on coronary plaque and FAI. The effect of low voltage on plaque composition is characterized by a polarization pattern, i.e., a decrease in fibrolipid (medium density) and an increase in necrotic core (low density) and calcification (high density). CLINICAL RELEVANCE STATEMENT Our results highlight the comparability and repeatability of plaque and pericoronary fat assessments facilitated by the same or a similar tube voltage. It is necessary to carry out studies on the specificity threshold of low tube voltage at each level. KEY POINTS • Low tube voltage had a significant effect on coronary plaque and pericoronary fat, particularly 70 kV. • The effect of low tube voltage on plaque composition shows the shift from medium-density mixed components to low- and high-density components. • It is necessary to correct the specificity threshold or attenuation difference for low tube voltage at each level.
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Affiliation(s)
- Yao Pan
- The Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhong Shan Road, Dalian, Liaoning, 116011, China
| | - Yaqi Gao
- The Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhong Shan Road, Dalian, Liaoning, 116011, China
| | - Zhaoqian Wang
- The Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhong Shan Road, Dalian, Liaoning, 116011, China
| | - Yana Dou
- Siemens Healthineers Ltd, No. 7, Wangjing Zhonghuan South Road, Beijing, 100102, China
| | - Xixia Sun
- The Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhong Shan Road, Dalian, Liaoning, 116011, China
| | - Zhiqiang Yang
- The Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhong Shan Road, Dalian, Liaoning, 116011, China
| | - Shuang Pan
- The Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhong Shan Road, Dalian, Liaoning, 116011, China
| | - Chongfu Jia
- The Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhong Shan Road, Dalian, Liaoning, 116011, China.
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Sun X, Zhu Y, Zhang N, Yuan K, Ling J, Ye J. Prognostic value of serial coronary computed tomography angiography-derived perivascular fat-attenuation index and plaque volume in patients with suspected coronary artery disease. Clin Radiol 2024; 79:599-607. [PMID: 38755080 DOI: 10.1016/j.crad.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
AIMS To investigate the prognostic value of serial coronary computed tomography angiography (CCTA) derived plaque information, fractional flow reserve (CT-FFR), and perivascular fat-attenuation index (FAI) on major adverse cardiac events (MACE) in patients with suspected coronary artery disease. MATERIALS AND METHODS A total of 252 patients who underwent serial CCTA between January 2018 and December 2021 and were followed until June 2022. MACE were recorded. The analysis indexes included percent diameter stenosis (%DS), lesion length, plaque volume, CT-FFR, and FAI, with an emphasis on their changes between the baseline and follow-up CCTAs. Multivariate regression analysis were employed to identify independent risk factors for MACE. RESULTS After a median follow-up of 48-month, MACE occurred in 32 patients (12.7%). Patients with MACE displayed more severe stenosis, longer lesions, and larger plaque volumes in both baseline and follow-up CCTAs compared with no-MACE patients (all P<0.05). Patients with MACE displayed more severe stenosis, longer lesion, and larger plaque volume in both baseline and follow-up CCTAs compared with no-MACE patients. In addition, MACE patients also showed lower CT-FFR and higher △CT-FFR. Although FAI was significantly higher in MACE patients at baseline CCTA, FAI was notably increased in MACE patients, and decreased in the no-MACE patients (all P<0.05). Logistic regression analysis showed that ΔFAI, %DS, and plaque volume were independent predictors of MACE, with ΔFAI being the most significant (OR: 16.725, P<0.000). A multivariable model showed a significantly improved C-index of 0.903 (95% confidence interval: 0.836-0.970) for MACE prediction, when compared with single index alone. CONCLUSIONS Serial CCTA-derived ΔFAI, %DS, and plaque volume are crucial independent predictors of MACE in patients with suspected coronary artery disease, highlighting the importance of CCTA in patient risk stratification and prognostic assessment.
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Affiliation(s)
- X Sun
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, PR China
| | - Y Zhu
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, PR China
| | - N Zhang
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, PR China
| | - K Yuan
- Department of Cadiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, PR China
| | - J Ling
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, PR China.
| | - J Ye
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, PR China.
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Debono S, Tzolos E, Syed MBJ, Nash J, Fletcher AJ, Dweck MR, Newby DE, Dey D, Forsythe RO, Williams MC. CT Attenuation of Periaortic Adipose Tissue in Abdominal Aortic Aneurysms. Radiol Cardiothorac Imaging 2024; 6:e230250. [PMID: 38329405 PMCID: PMC10912871 DOI: 10.1148/ryct.230250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/27/2023] [Accepted: 12/29/2023] [Indexed: 02/09/2024]
Abstract
Purpose To assess periaortic adipose tissue attenuation at CT angiography in different abdominal aortic aneurysm disease states. Materials and Methods In a retrospective observational study from January 2018 to December 2022, periaortic adipose tissue attenuation was assessed at CT angiography in patients with asymptomatic or symptomatic (including rupture) abdominal aortic aneurysms and controls without aneurysms. Adipose tissue attenuation was measured using semiautomated software in periaortic aneurysmal and nonaneurysmal segments of the abdominal aorta and in subcutaneous and visceral adipose tissue. Periaortic adipose tissue attenuation values between the three groups were assessed using Student t tests and Wilcoxon rank sum tests followed by a multiregression model. Results Eighty-eight individuals (median age, 70 years [IQR, 65-78]; 78 male and 10 female patients) were included: 70 patients with abdominal aortic aneurysms (40 asymptomatic and 30 symptomatic, including 24 with rupture) and 18 controls. There was no evidence of differences in the periaortic adipose tissue attenuation in the aneurysmal segment in asymptomatic patients versus controls (-81.44 HU ± 7 [SD] vs -83.27 HU ± 9; P = .43) and attenuation in nonaneurysmal segments between asymptomatic patients versus controls (-75.43 HU ± 8 vs -78.81 HU ± 6; P = .08). However, symptomatic patients demonstrated higher periaortic adipose tissue attenuation in both aneurysmal (-57.85 HU ± 7; P < .0001) and nonaneurysmal segments (-58.16 HU ± 8; P < .0001) when compared with the other two groups. Conclusion Periaortic adipose tissue CT attenuation was not increased in stable abdominal aortic aneurysm disease. There was a generalized increase in attenuation in patients with symptomatic disease, likely reflecting the systemic consequences of acute rupture. Keywords: Abdominal Aortic Aneurysm, Periaortic Adipose Tissue Attenuation, CT Angiography ClinicalTrials.gov registration no. NCT02229006 © RSNA, 2024.
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Affiliation(s)
- Samuel Debono
- From the University of Edinburgh Centre for Cardiovascular Science,
University of Edinburgh, 49 Little France Crescent, Chancellor’s
Building, Room SU.305, Edinburgh EH16 4SB, United Kingdom (S.D., E.T.,
M.B.J.S., J.N., A.J.F., M.R.D., D.E.N., R.O.F., M.C.W.); School of
Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United
Kingdom (A.J.F.); Department of Medicine, Division of Artificial Intelligence,
and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (D.D.); and Edinburgh Vascular Service, Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, United Kingdom (R.O.F.)
| | - Evangelos Tzolos
- From the University of Edinburgh Centre for Cardiovascular Science,
University of Edinburgh, 49 Little France Crescent, Chancellor’s
Building, Room SU.305, Edinburgh EH16 4SB, United Kingdom (S.D., E.T.,
M.B.J.S., J.N., A.J.F., M.R.D., D.E.N., R.O.F., M.C.W.); School of
Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United
Kingdom (A.J.F.); Department of Medicine, Division of Artificial Intelligence,
and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (D.D.); and Edinburgh Vascular Service, Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, United Kingdom (R.O.F.)
| | - Maaz B. J. Syed
- From the University of Edinburgh Centre for Cardiovascular Science,
University of Edinburgh, 49 Little France Crescent, Chancellor’s
Building, Room SU.305, Edinburgh EH16 4SB, United Kingdom (S.D., E.T.,
M.B.J.S., J.N., A.J.F., M.R.D., D.E.N., R.O.F., M.C.W.); School of
Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United
Kingdom (A.J.F.); Department of Medicine, Division of Artificial Intelligence,
and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (D.D.); and Edinburgh Vascular Service, Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, United Kingdom (R.O.F.)
| | - Jennifer Nash
- From the University of Edinburgh Centre for Cardiovascular Science,
University of Edinburgh, 49 Little France Crescent, Chancellor’s
Building, Room SU.305, Edinburgh EH16 4SB, United Kingdom (S.D., E.T.,
M.B.J.S., J.N., A.J.F., M.R.D., D.E.N., R.O.F., M.C.W.); School of
Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United
Kingdom (A.J.F.); Department of Medicine, Division of Artificial Intelligence,
and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (D.D.); and Edinburgh Vascular Service, Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, United Kingdom (R.O.F.)
| | - Alexander J. Fletcher
- From the University of Edinburgh Centre for Cardiovascular Science,
University of Edinburgh, 49 Little France Crescent, Chancellor’s
Building, Room SU.305, Edinburgh EH16 4SB, United Kingdom (S.D., E.T.,
M.B.J.S., J.N., A.J.F., M.R.D., D.E.N., R.O.F., M.C.W.); School of
Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United
Kingdom (A.J.F.); Department of Medicine, Division of Artificial Intelligence,
and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (D.D.); and Edinburgh Vascular Service, Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, United Kingdom (R.O.F.)
| | - Marc R. Dweck
- From the University of Edinburgh Centre for Cardiovascular Science,
University of Edinburgh, 49 Little France Crescent, Chancellor’s
Building, Room SU.305, Edinburgh EH16 4SB, United Kingdom (S.D., E.T.,
M.B.J.S., J.N., A.J.F., M.R.D., D.E.N., R.O.F., M.C.W.); School of
Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United
Kingdom (A.J.F.); Department of Medicine, Division of Artificial Intelligence,
and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (D.D.); and Edinburgh Vascular Service, Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, United Kingdom (R.O.F.)
| | - David E. Newby
- From the University of Edinburgh Centre for Cardiovascular Science,
University of Edinburgh, 49 Little France Crescent, Chancellor’s
Building, Room SU.305, Edinburgh EH16 4SB, United Kingdom (S.D., E.T.,
M.B.J.S., J.N., A.J.F., M.R.D., D.E.N., R.O.F., M.C.W.); School of
Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United
Kingdom (A.J.F.); Department of Medicine, Division of Artificial Intelligence,
and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (D.D.); and Edinburgh Vascular Service, Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, United Kingdom (R.O.F.)
| | - Damini Dey
- From the University of Edinburgh Centre for Cardiovascular Science,
University of Edinburgh, 49 Little France Crescent, Chancellor’s
Building, Room SU.305, Edinburgh EH16 4SB, United Kingdom (S.D., E.T.,
M.B.J.S., J.N., A.J.F., M.R.D., D.E.N., R.O.F., M.C.W.); School of
Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United
Kingdom (A.J.F.); Department of Medicine, Division of Artificial Intelligence,
and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (D.D.); and Edinburgh Vascular Service, Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, United Kingdom (R.O.F.)
| | - Rachael O. Forsythe
- From the University of Edinburgh Centre for Cardiovascular Science,
University of Edinburgh, 49 Little France Crescent, Chancellor’s
Building, Room SU.305, Edinburgh EH16 4SB, United Kingdom (S.D., E.T.,
M.B.J.S., J.N., A.J.F., M.R.D., D.E.N., R.O.F., M.C.W.); School of
Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United
Kingdom (A.J.F.); Department of Medicine, Division of Artificial Intelligence,
and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (D.D.); and Edinburgh Vascular Service, Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, United Kingdom (R.O.F.)
| | - Michelle C. Williams
- From the University of Edinburgh Centre for Cardiovascular Science,
University of Edinburgh, 49 Little France Crescent, Chancellor’s
Building, Room SU.305, Edinburgh EH16 4SB, United Kingdom (S.D., E.T.,
M.B.J.S., J.N., A.J.F., M.R.D., D.E.N., R.O.F., M.C.W.); School of
Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United
Kingdom (A.J.F.); Department of Medicine, Division of Artificial Intelligence,
and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (D.D.); and Edinburgh Vascular Service, Royal Infirmary of
Edinburgh, NHS Lothian, Edinburgh, United Kingdom (R.O.F.)
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Yu MM, Zhao X, Chen YY, Tao XW, Ge JB, Jin H, Zeng MS. Evolocumab attenuate pericoronary adipose tissue density via reduction of lipoprotein(a) in type 2 diabetes mellitus: a serial follow-up CCTA study. Cardiovasc Diabetol 2023; 22:121. [PMID: 37217967 DOI: 10.1186/s12933-023-01857-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Pericoronary adipose tissue (PCAT) density is a biomarker of vessel inflammation, which is supposed to be increased in patients with type 2 diabetes mellitus (T2DM). However, whether the coronary inflammation revealed by this novel index could be alleviated after evolocumab treatment in T2DM remains unknown. METHODS From January 2020 to December 2022, consecutive T2DM patients with low-density lipoprotein cholesterol ≥ 70 mg/dL on maximally tolerated statin and taking evolocumab were prospectively included. In addition, patients with T2DM who were taking statin alone were recruited as control group. The eligible patients underwent baseline and follow-up coronary CT angiography with an interval of 48-week. To render patients with evolocumab as comparable to those controls, a propensity-score matching design was used to select the matched pairs with a 1:1 ratio. Obstructive lesion was defined as the extent of coronary artery stenosis ≥ 50%; the numbers inside the brackets were interquartile ranges. RESULTS A total of 170 T2DM patients with stable chest pain were included [(mean age 64 ± 10.6 [range 40-85] years; 131 men). Among those patients, 85 were in evolocumab group and 85 were in control group. During follow-up, low-density lipoprotein cholesterol (LDL-C) level (2.02 [1.26, 2.78] vs. 3.34 [2.53, 4.14], p < 0.001), and lipoprotein(a) (12.1 [5.6, 21.8] vs. 18.9 [13.2, 27.2], p = 0.002) were reduced after evolocumab treatment. The prevalence of obstructive lesions and high-risk plaque features were significantly decreased (p < 0.05 for all). Furthermore, the calcified plaque volume were significantly increased (188.3 [115.7, 361.0] vs. 129.3 [59.5, 238.3], p = 0.015), while the noncalcified plaque volume and necrotic volume were diminished (107.5 [40.6, 180.6] vs. 125.0 [65.3, 269.7], p = 0.038; 0 [0, 4.7] vs. 0 [0, 13.4], p < 0.001, respectively). In addition, PCAT density of right coronary artery was significantly attenuated in evolocumab group (- 85.0 [- 89.0, - 82.0] vs. - 79.0 [- 83.5, - 74.0], p < 0.001). The change in the calcified plaque volume inversely correlated with achieved LDL-C level (r = - 0.31, p < 0.001) and lipoprotein(a) level (r = - 0.33, p < 0.001). Both the changes of noncalcified plaque volume and necrotic volume were positively correlated with achieved LDL-C level and Lp(a) (p < 0.001 for all). However, the change of PCATRCA density only positively correlated with achieved lipoprotein(a) level (r = 0.51, p < 0.001). Causal mediation analysis revealed Lp(a) level mediated 69.8% (p < 0.001) for the relationship between evolocumab and changes of PCATRCA. CONCLUSIONS In patients with T2DM, evolocumab is an effective therapy to decrease noncalcified plaque volume necrotic volume, and increase calcified plaque volume. Furthermore, evolocumab could attenuate PCAT density, at least in part, via the reduction of lipoprotein(a).
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Affiliation(s)
- Meng-Meng Yu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Xin Zhao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yin-Yin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Xin-Wei Tao
- Bayer Healthcare, No. 399, West Haiyang Road, Shanghai, 200126, China
| | - Jun-Bo Ge
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
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