Klüner Laura V, Oikonomou Evangelos K, Antoniades Charalambos
Division of Cardiovascular Medicine (L.V.K., E.K.O., C.A.) and Acute Vascular Imaging Centre (C.A.), Radcliffe Department of Medicine, Level 6, West Wing, University of Oxford, Oxford OX3 9DU, England; and Department of Internal Medicine, School of Medicine, Yale University, New Haven, Conn (E.K.O.).
Radiol Cardiothorac Imaging. 2021 Feb 25;3(1):e200563. doi: 10.1148/ryct.2021200563. eCollection 2021 Feb.
Coronary CT angiography (CCTA) has evolved into a first-line diagnostic test for the investigation of chest pain. Despite advances toward standardizing the reporting of CCTA through the Coronary Artery Disease Reporting and Data System (or CAD-RADS) tool, the prognostic value of CCTA in the earliest stages of atherosclerosis remains limited. Translational work on the bidirectional interplay between the coronary arteries and the perivascular adipose tissue (PVAT) has highlighted PVAT as an in vivo molecular sensor of coronary inflammation. Coronary inflammation is dynamically associated with phenotypic changes in its adjacent PVAT, which can now be detected as perivascular attenuation gradients at CCTA. These gradients are captured and quantified through the fat attenuation index (FAI), a CCTA-based biomarker of coronary inflammation. FAI carries significant prognostic value in both primary and secondary prevention (patients with and without established coronary artery disease) and offers a significant improvement in cardiac risk discrimination beyond traditional risk factors, such as coronary calcium, high-risk plaque features, or the extent of coronary atherosclerosis. Thanks to its dynamic nature, FAI may be used as a marker of disease activity, with observational studies further suggesting that it tracks the response to anti-inflammatory interventions. Finally, radiotranscriptomic studies have revealed complementary radiomic patterns of PVAT, which detect more permanent adverse fibrotic and vascular PVAT remodeling, further expanding the value of PVAT phenotyping as an important readout in modern CCTA analysis. © RSNA, 2021.
冠状动脉CT血管造影（CCTA）已发展成为胸痛检查的一线诊断测试。尽管通过冠状动脉疾病报告和数据系统（CAD-RADS）工具在规范CCTA报告方面取得了进展，但CCTA在动脉粥样硬化最早阶段的预后价值仍然有限。关于冠状动脉与血管周围脂肪组织（PVAT）之间双向相互作用的转化研究强调了PVAT作为冠状动脉炎症的体内分子传感器。冠状动脉炎症与其相邻PVAT的表型变化动态相关，现在可以在CCTA上检测为血管周围衰减梯度。这些梯度通过脂肪衰减指数（FAI）进行捕获和量化，FAI是基于CCTA的冠状动脉炎症生物标志物。FAI在一级和二级预防（有和没有已确诊冠状动脉疾病的患者）中均具有显著的预后价值，并且在区分心脏风险方面比传统风险因素（如冠状动脉钙化、高危斑块特征或冠状动脉粥样硬化程度）有显著改善。由于其动态性质，FAI可作为疾病活动的标志物，观察性研究进一步表明它可追踪对抗炎干预的反应。最后，放射转录组学研究揭示了PVAT的互补性放射组学模式，可检测到更持久的不良纤维化和血管PVAT重塑，进一步扩大了PVAT表型分析作为现代CCTA分析中重要读出指标的价值。©RSNA，2021年。
