Luo Wei, Lv Peng, Zhang Ranying, Qiu Qixuan, Lin Jiang
Shanghai Institute of Medical Imaging, Shanghai, China.
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Eur Radiol. 2025 Jun 3. doi: 10.1007/s00330-025-11713-y.
This study aimed to investigate the relationship between perivascular fat density (PFD) and carotid plaque characteristics while exploring the additive diagnostic value of PFD in predicting symptomatic carotid plaques.
In a single-center retrospective case-control study, 315 patients with unilateral carotid atherosclerosis were classified into symptomatic and asymptomatic groups based on the presence of acute ischemic stroke or transient ischemic attack (TIA) within 2 weeks before carotid computed tomography angiography (CTA). Plaque CTA features and PFD were assessed, and their relationship was analyzed using Spearman's rank correlation. Logistic regression analysis was employed to identify risk factors for symptomatic carotid plaques, and predictive models were subsequently developed. The performance of these models was further evaluated.
A positive linear correlation was found between PFD and plaque CTA characteristics (p < 0.05). PFD, degree of stenosis, plaque burden, and soft plaque thickness were identified as predictors of symptomatic carotid plaques. Receiver operating characteristic (ROC) curves showed that the areas under the curves (AUC) increased from 0.631 to 0.846 with the addition of plaque burden, soft plaque thickness, and PFD to a degree of stenosis. The calibration curves of the combined model with PFD and plaque risk features demonstrated good predictive consistency. Decision curve analysis suggested that the combined model provided higher clinical benefit.
PFD may serve as a valuable imaging marker for vulnerable plaques, providing additional diagnostic value in risk assessment. The combination of PFD with plaque risk features may further enhance the predictive performance of symptomatic carotid plaques.
Question Does perivascular fat density (PFD) add additional predictive value to plaque risk features on CT angiography (CTA) in the assessment of symptomatic carotid plaques? Findings PFD provides additive predictive value for symptomatic carotid plaques. Combining PFD with stenosis severity and plaque CTA features improves prediction. Clinical relevance PFD may serve as a valuable imaging biomarker for risk stratification and clinical decision-making in carotid atherosclerosis.
本研究旨在探讨血管周围脂肪密度（PFD）与颈动脉斑块特征之间的关系，同时探索PFD在预测有症状颈动脉斑块方面的附加诊断价值。
在一项单中心回顾性病例对照研究中，315例单侧颈动脉粥样硬化患者根据颈动脉计算机断层血管造影（CTA）前2周内是否存在急性缺血性卒中或短暂性脑缺血发作（TIA）分为有症状组和无症状组。评估斑块CTA特征和PFD，并使用Spearman等级相关性分析它们之间的关系。采用逻辑回归分析确定有症状颈动脉斑块的危险因素，随后建立预测模型。进一步评估这些模型的性能。
发现PFD与斑块CTA特征之间存在正线性相关性（p < 0.05）。PFD、狭窄程度、斑块负荷和软斑块厚度被确定为有症状颈动脉斑块的预测因素。受试者操作特征（ROC）曲线显示，在狭窄程度的基础上增加斑块负荷、软斑块厚度和PFD后，曲线下面积（AUC）从0.631增加到0.846。PFD与斑块风险特征的联合模型的校准曲线显示出良好的预测一致性。决策曲线分析表明联合模型具有更高的临床效益。
PFD可能是易损斑块的一个有价值的影像学标志物，在风险评估中提供附加诊断价值。PFD与斑块风险特征的联合可能进一步提高有症状颈动脉斑块的预测性能。
问题 血管周围脂肪密度（PFD）在评估有症状颈动脉斑块时，是否能为CT血管造影（CTA）上的斑块风险特征增加额外的预测价值？ 发现 PFD为有症状颈动脉斑块提供附加预测价值。将PFD与狭窄严重程度和斑块CTA特征相结合可改善预测。 临床意义 PFD可能是颈动脉粥样硬化风险分层和临床决策中有价值的影像学生物标志物。
