Towards universal comparability of pericoronary adipose tissue attenuation: a coronary computed tomography angiography phantom study

Dominik Etter; Geoff Warnock; Frederic Koszarski; Tilo Niemann; Nidaa Mikail; Susan Bengs; Ronny R Buechel; Philipp Kaufmann; Cathérine Gebhard; Alexia Rossi

doi:10.1007/s00330-022-09274-5

Towards universal comparability of pericoronary adipose tissue attenuation: a coronary computed tomography angiography phantom study

Eur Radiol. 2023 Apr;33(4):2324-2330. doi: 10.1007/s00330-022-09274-5. Epub 2022 Dec 6.

Authors

Dominik Etter^#^{1

2}, Geoff Warnock^#^{1

2}, Frederic Koszarski¹, Tilo Niemann³, Nidaa Mikail^{1

2}, Susan Bengs^{1

2}, Ronny R Buechel¹, Philipp Kaufmann¹, Cathérine Gebhard^{1

2}, Alexia Rossi^#^{4

5}

Affiliations

¹ Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
² Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland.
³ Department of Radiology, Kantonsspital Baden, 5400, Baden, Switzerland.
⁴ Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. alexia.rossi@usz.ch.
⁵ Center for Molecular Cardiology, University of Zurich, 8952, Schlieren, Switzerland. alexia.rossi@usz.ch.

^# Contributed equally.

Abstract

Objectives: Different computed tomography (CT) scanners, variations in acquisition protocols, and technical parameters employed for image reconstruction may introduce bias in the analysis of pericoronary adipose tissue (PCAT) attenuation derived from coronary computed tomography angiography (CCTA). Therefore, the aim of this study was to establish the effect of tube voltage, measured as kilovoltage peak (kVp), and iterative reconstruction on PCAT mean attenuation (PCAT_MA).

Methods: Twelve healthy ex vivo porcine hearts were injected with iodine-enriched agar-agar to allow for ex vivo CCTA imaging on a 256-slice CT and a dual-source CT system. Images were acquired at tube voltages of 80, 100, 120, and 140 kVp and reconstructed by using both filtered back projection and iterative reconstruction algorithms. PCAT_MA was measured semi-automatically on CCTA images in the proximal segment of coronary arteries.

Results: The tube voltage showed a significant effect on PCAT_MA measurements on both the 256-slice CT scanner (p < 0.001) and the dual-source CT system (p = 0.013), resulting in higher attenuation values with increasing tube voltage. Similarly, the use of iterative reconstructions was associated with a significant increase of PCAT_MA (256-slice CT: p < 0.001 and dual-source CT: p = 0.014). Averaged conversion factors to correct PCAT_MA measurements for tube voltage other than 120 kVp were 1.267, 1.080 and 0.947 for 80, 100, and 140 kVp, respectively.

Conclusion: PCAT_MA values are significantly affected by acquisition and reconstruction parameters. The same tube voltage and reconstruction type are recommended when PCAT attenuation is used in multicenter and longitudinal studies.

Key points: • The tube voltage used for CCTA acquisition affects pericoronary adipose tissue attenuation, resulting in higher attenuation values of fat with increasing tube voltage. • Conversion factors for pericoronary adipose tissue attenuation values could be used to adjust for differences in attenuation between scans performed at different tube voltages. • In longitudinal CCTA studies employing pericoronary adipose tissue attenuation as imaging endpoint, it is recommended to maintain tube voltage and image reconstruction type constant across serial scans.

Keywords: Adipose tissue; Computed tomography angiography; Coronary arteries; Image reconstruction.

Publication types

Multicenter Study

MeSH terms

Adipose Tissue / diagnostic imaging
Agar
Animals
Computed Tomography Angiography* / methods
Contrast Media* / pharmacology
Coronary Angiography / methods
Radiographic Image Interpretation, Computer-Assisted / methods
Swine
Tomography, X-Ray Computed / methods

Substances

Contrast Media
Agar