Effect of Vessel Attenuation, VMI Level, and Reconstruction Kernel on Pericoronary Adipose Tissue Attenuation for EID CT and PCD CT: An Ex Vivo Porcine Heart Study.

Abstract

BACKGROUND. Pericoronary adipose tissue (PCAT) attenuation and the fat attenuation index (FAI) may serve as markers of inflammation and the risk of adverse cardiac events. However, standardization of relevant CT acquisition and reconstruction parameters is lacking. OBJECTIVE. The purpose of this study was to investigate the influence of vessel attenuation, the virtual monoenergetic image (VMI) level, and the reconstruction kernel on PCAT attenuation and FAI by use of energy-integrating detector (EID) and photon-counting detector (PCD) CT systems in an ex vivo porcine heart model. METHODS. The right coronary artery (RCA) of a porcine heart was injected with saline or varying contrast medium dilutions to achieve vessel attenuation ranging from 0 to 1000 HU. After each injection, the heart was sequentially scanned by EID CT at 120 kVp and PCD CT at 140 kVp at a constant CTDI_vol of 10 mGy. For EID CT, polychromatic images were reconstructed with a Qr40 kernel. For PCD CT, VMIs (obtained at 40-80 keV in 10-keV increments) were reconstructed with Qr40, Bv40, and Bv56 kernels. ROIs were placed to measure RCA and PCAT attenuation. FAI was determined using software; histogram analysis was performed to assess voxel attenuation in the volumes of interest for FAI calculation. RESULTS. Correlations were observed between attenuation in the RCA and attenuation in the adjacent PCAT (r = 0.3-1.0) and between vessel attenuation and the FAI (r = -0.9 to 1.0). For PCAT attenuation and the FAI, these associations became progressively weaker when progressively sharper kernels were used. For increasing vessel attenuation on EID CT and for increasing VMI level on PCD CT, FAI histograms showed right shifts in peak attenuation values; the percentage of histogram voxels that met the threshold range for inclusion in FAI calculation was 9-38% for EID CT and 6-39% for PCD CT at VMI levels of 70-80 keV. For PCD CT, use of sharper kernels was associated with left shifts in peak attenuation values and greater percentages of voxels within the threshold range for inclusion in FAI calculation. CONCLUSION. PCAT attenuation and the FAI are influenced by vessel lumen attenuation, the VMI level, and the reconstruction kernel. A minority of pericoronary voxels contribute to FAI measurements for polychromatic EID CT and for PCD CT at high VMI levels. CLINICAL IMPACT. These findings may help standardize acquisition and reconstruction parameters for PCAT attenuation and FAI measurements.