Towards reference values of pericoronary adipose tissue attenuation: impact of coronary artery and tube voltage in coronary computed tomography angiography

Runlei Ma; Daan Ties; Marly van Assen; Gert Jan Pelgrim; Grigory Sidorenkov; Peter M A van Ooijen; Pim van der Harst; Randy van Dijk; Rozemarijn Vliegenthart

doi:10.1007/s00330-020-07069-0

Towards reference values of pericoronary adipose tissue attenuation: impact of coronary artery and tube voltage in coronary computed tomography angiography

Eur Radiol. 2020 Dec;30(12):6838-6846. doi: 10.1007/s00330-020-07069-0. Epub 2020 Jul 22.

Authors

Affiliations

¹ Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.
² Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
³ Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁴ Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁵ Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁶ Data Science Center in Health, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁷ Department of Radiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands. r.vliegenthart@umcg.nl.

Abstract

Objectives: To determine normal pericoronary adipose tissue mean attenuation (PCAT_MA) values for left the anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) in patients without plaques on coronary CT angiography (cCTA), taking into account tube voltage influence.

Methods: This retrospective study included 192 patients (76 (39.6%) men; median age 49 years (range, 19-79)) who underwent cCTA with third-generation dual-source CT for the suspicion of CAD between 2015 and 2017. We selected patients without plaque on cCTA. PCAT_MA was measured semi-automatically on cCTA images in the proximal segment of the three main coronary arteries with 10 mm length. Paired t-testing was used to compare PCAT_MA between combinations of two coronary arteries within each patient, and one-way ANOVA testing was used to compare PCAT_MA in different kV groups.

Results: The overall mean ± standard deviation (SD) PCAT_MA was - 90.3 ± 11.1 HU. PCAT_MA in men was higher than that in women: - 88.5 ± 10.5 HU versus - 91.5 ± 11.3 HU (p = 0.001). PCAT_MA of LAD, LCX, and RCA was - 92.4 ± 11.6 HU, - 88.4 ± 9.9 HU, and - 90.2 ± 11.4 HU, respectively. Pairwise comparison of the arteries showed significant difference in PCAT_MA: LAD and LCX (p < 0.001), LAD and RCA (p = 0.009), LCX and RCA (p = 0.033). PCAT_MA of the 70 kV, 80 kV, 90 kV, 100 kV, and 120 kV groups was - 95.6 ± 9.6 HU, - 90.2 ± 11.5 HU, - 87.3 ± 9.9 HU, - 82.7 ± 6.2 HU, and - 79.3 ± 6.8 HU, respectively (p < 0.001).

Conclusions: In patients without plaque on cCTA, PCAT_MA varied by tube voltage, with minor differences in PCAT_MA between coronary arteries (LAD, LCX, RCA). PCAT_MA values need to be interpreted taking into account tube voltage setting.

Key points: • In patients without plaque on cCTA, PCAT_MA differs slightly by coronary artery (LAD, LCX, RCA). • Tube voltage of cCTA affects PCAT_MA measurement, with mean PCAT_MA increasing linearly with increasing kV. • For longitudinal cCTA analysis of PCAT_MA , the use of equal kV setting is strongly recommended.

Keywords: Adipose tissue; Atherosclerosis; Computed tomography angiography; Coronary vessels/diagnostic imaging; Reproducibility of results.

MeSH terms

Adipose Tissue / diagnostic imaging*
Adult
Aged
Computed Tomography Angiography*
Coronary Angiography*
Coronary Vessels / diagnostic imaging*
Female
Humans
Male
Middle Aged
Plaque, Atherosclerotic / diagnostic imaging*
Reference Values
Reproducibility of Results
Retrospective Studies
Young Adult