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

ObjectivesDifferent 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)). MethodsTwelve 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. ResultsThe 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. ConclusionPCAT(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.

Automated summary

This study aimed to investigate the impact of tube voltage and iterative reconstruction on the mean attenuation of pericoronary adipose tissue (PCAT(MA)) derived from coronary computed tomography angiography (CCTA). It was found that both tube voltage and reconstruction type significantly affected PCAT(MA), and it is recommended to use the same tube voltage and reconstruction type in multicenter and longitudinal studies.