Analysis of Pericoronary Adipose Tissue in Cardiac CT Perfusion (CCTP) Images Highlights the Confounds in CCTA

Introduction: Pericoronary adipose tissue (PCAT) assessments have been associated with coronary artery disease and MACE. Elevated PCAT HU, as assessed from the fat attenuation index (FAI), has been associated with inflammation. Such assessments are made using coronary CTA (CCTA) images, where there is a potential confound on both HU and spatial features due to the presence of iodine, especially when one considers the dynamics of fat perfusion, multiple factors that affect the shape of the iodine bolus, the impact of obstructive disease, and the timing of CCTA acquisition. Using dynamic cardiac computed tomography perfusion (CCTP), we analyzed PCAT iodine perfusion and its role on PCAT HU and spatial features.