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. 2023 Apr;33(4):2450-2460.
doi: 10.1007/s00330-022-09257-6. Epub 2022 Dec 3.

Assessment of epicardial adipose tissue on virtual non-contrast images derived from photon-counting detector coronary CTA datasets

Franka Risch  1 , Florian Schwarz  1   2 , Franziska Braun  1 , Stefanie Bette  1 , Judith Becker  1 , Christian Scheurig-Muenkler  1 , Thomas J Kroencke  3 , Josua A Decker  1
Affiliations

Assessment of epicardial adipose tissue on virtual non-contrast images derived from photon-counting detector coronary CTA datasets

Franka Risch et al. Eur Radiol. 2023 Apr.

Abstract

Objectives: To assess epicardial adipose tissue (EAT) volume and attenuation of different virtual non-contrast (VNC) reconstructions derived from coronary CTA (CCTA) datasets of a photon-counting detector (PCD) CT-system to replace true non-contrast (TNC) series.

Methods: Consecutive patients (n = 42) with clinically indicated CCTA and coronary TNC were included. Two VNC series were reconstructed, using a conventional (VNCConv) and a novel calcium-preserving (VNCPC) algorithm. EAT was segmented on TNC, VNCConv, VNCPC, and CCTA (CTA-30) series using thresholds of -190 to -30 HU and an additional segmentation on the CCTA series with an upper threshold of 0 HU (CTA0). EAT volumes and their histograms were assessed for each series. Linear regression was used to correlate EAT volumes and the Euclidian distance for histograms. The paired t-test and the Wilcoxon signed-rank test were used to assess differences for parametric and non-parametric data.

Results: EAT volumes from VNC and CCTA series showed significant differences compared to TNC (all p < .05), but excellent correlation (all R2 > 0.9). Measurements on the novel VNCPC series showed the best correlation (R2 = 0.99) and only minor absolute differences compared to TNC values. Mean volume differences were -12%, -3%, -13%, and +10% for VNCConv, VNCPC, CTA-30, and CTA0 compared to TNC. Distribution of CT values on VNCPC showed less difference to TNC than on VNCConv (mean attenuation difference +7% vs. +2%; Euclidean distance of histograms 0.029 vs. 0.016).

Conclusions: VNCPC-reconstructions of PCD-CCTA datasets can be used to reliably assess EAT volume with a high accuracy and only minor differences in CT values compared to TNC. Substitution of TNC would significantly decrease patient's radiation dose.

Key points: • Measurement of epicardial adipose tissue (EAT) volume and attenuation are feasible on virtual non-contrast (VNC) series with excellent correlation to true non-contrast series (all R2>0.9). • Differences in VNC algorithms have a significant impact on EAT volume and CT attenuation values. • A novel VNC algorithm (VNCPC) enables reliable assessment of EAT volume and attenuation with superior accuracy compared to measurements on conventional VNC- and CCTA-series.

Keywords: Adipose tissue; Computed tomography angiography; Heart; Medical image processing; Radiation dosage.

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Conflict of interest statement

The authors of this manuscript declare relationships with the following companies:

Prof. Kroencke discloses receives institutional research support from Siemens Healthineers and Dr. Schwarz has received speaker honoraria from Siemens Healthineers. All other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
Demonstration of EAT segmentations, their volumes, and histograms. EAT = epicardial adipose tissue; CTA0 = CT angiography with an upper threshold of 0 HU; CTA-30 = CT angiography with an upper threshold of −30 HU; TNC = true non-contrast; VNCConv = conventional virtual non-contrast; VNCPC = PureCalcium virtual non-contrast
Fig. 2
Fig. 2
Boxplot of the measured epicardial adipose tissue volume in mL. EAT = epicardial adipose tissue; CTA0 = CT angiography with an upper threshold of 0 HU; CTA-30 = CT angiography with an upper threshold of −30 HU; TNC = true non-contrast; VNCConv = conventional virtual non-contrast; VNCPC = PureCalcium virtual non-contrast
Fig. 3
Fig. 3
Mean difference plots between the EAT volumes in mL measured on TNC and the respective volumes measured on CTA and VNC. EAT = epicardial adipose tissue; CTA0 = CT angiography with an upper threshold of 0 HU; CTA-30 = CT angiography with an upper threshold of −30 HU; TNC = true non-contrast; VNCConv = conventional virtual non-contrast; VNCPC = PureCalcium virtual non-contrast.
Fig. 4
Fig. 4
Linear regression plots between the EAT volumes in mL measured on TNC and the respective volumes measured on CTA and VNC. EAT = epicardial adipose tissue; CTA0 = CT angiography with an upper threshold of 0 HU; CTA-30 = CT angiography with an upper threshold of −30 HU; TNC = true non-contrast; VNCConv = conventional virtual non-contrast; VNCPC = PureCalcium virtual non-contrast
Fig. 5
Fig. 5
A Boxplot of the mean CT values measured within the segmented EAT volumes. EAT = epicardial adipose tissue; CTA-30 = CT angiography with an upper threshold of −30 HU; TNC = true non-contrast; VNCConv = conventional virtual non-contrast; VNCPC = PureCalcium virtual non-contrast. B Boxplot of the standard deviation of CT values measured within the segmented EAT volumes. EAT = epicardial adipose tissue; CTA-30 = CT angiography with an upper threshold of −30 HU; TNC = true non-contrast; VNCConv = conventional virtual non-contrast; VNCPC = PureCalcium virtual non-contrast
Fig. 6
Fig. 6
A Plots of the histograms divided by their total number of voxels and averaged over all patients for the respective image series. CTA-30 = CT angiography with an upper threshold of −30 HU; TNC = true non-contrast; VNCConv = conventional virtual non-contrast; VNCPC = PureCalcium virtual non-contrast. B Boxplots of the Euclidean distance between the histograms of TNC and the respective histograms of CTA-30 and VNC. CTA-30 = CT angiography with an upper threshold of −30 HU; TNC = true non-contrast; VNCConv = conventional virtual non-contrast; VNCPC = PureCalcium virtual non-contrast
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