Towards pericoronary adipose tissue as a clinical imaging marker for coronary inflammation

Early detection and treatment of coronary atherosclerosis is essential in reducing the impact of coronary artery disease (CAD). Inflammation plays an important role in the development of coronary atherosclerosis, often preceding plaque formation. Therefore, the ability to detect and monitor coronary inflammation may add value in the early diagnosis and treatment of CAD. Coronary computed tomography angiography (CCTA) has recently gained a central role in non-invasive evaluation of CAD in patients with chest pain. The density of fat around the coronary arteries (pericoronary adipose tissue mean attenuation, PCATMA) has emerged as a promising imaging biomarker for evaluating coronary inflammation on CCTA. In this thesis, we focused on furthering the development of PCATMA as imaging biomarker. We found that PCATMA values differed by the tube voltage of the CT scan, and by coronary artery. We determined normal values of PCATMA in a cohort of patients without CAD on CCTA. Interestingly, PCATMA was higher in men than in women. Compared to coronary arteries without plaque, PCATMA was higher in coronary arteries with plaque, in particularly directly around the plaque. We conclude that standardizing scan parameters is essential for minimizing variation in PCATMA across studies and patients. Furthermore, consensus on the exact measurement methodology, is needed for consistent and reliable interpretation. Our findings emphasize the importance of considering sex, tube voltage and coronary artery when interpreting PCATMA.