Research on Risk Assessment of High-risk Plaque Risk Based on Pericoronary Fat Quantification via CCTA
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摘要:
目的 以斑块冠周脂肪衰减指数（fat attenuation index，FAI）值为参考标准，探讨不同高危特征数量及组合的高危斑块风险程度。 方法 回顾性收集2022年9月至2024年6月行冠状动脉CT血管成像（coronary CT angiography，CCTA）且单支冠脉仅存在高危斑块或非高危斑块的患者331例，共纳入399处斑块，其中高危斑块289处、非高危斑块110处。根据斑块是否具有高危特征、高危特征数量、特征组合及是否包含点状钙化或餐巾环征进行分组，测量斑块周围FAI。以FAI值为评估斑块风险性的参考标准，确定识别高危斑块的FAI阈值，并比较不同特征数量及组成的高危斑块风险差异，最终对患者进行随访及对所得结果进行外部验证。 结果 高危斑块的FAI识别阈值为-74.5 Hu。含2种高危特征的斑块FAI值低于含3种或4种高危特征的斑块，差异具有统计学意义（P < 0.05）；3种与4种高危特征组间FAI值差异无统计学意义（P > 0.05）。低密度合并正性重构斑块的FAI值高于点状钙化合并正性重构斑块，差异显著（P < 0.01）；有餐巾环征组FAI值高于无餐巾环征组（P < 0.05）；有点状钙化组FAI值低于无点状钙化组，但差异无统计学意义（P > 0.05）；外部验证高危组FAI值显著高于非高危组（P < 0.001），MACE 事件全部发生于高危组，低密度斑块+正性重构特征及含餐巾环征特征的分布亦呈现相似趋势，且均有统计学意义（P < 0.05）。 结论 结合冠脉斑块高危特征的数量与组合，可对斑块发生急性冠脉综合征的风险进行分层评估。 -
关键词:
- 冠状动脉CT血管成像 /
- 脂肪衰减指数 /
- 高危斑块 /
- 风险分层 /
- 急性冠脉综合征
Abstract:Objective To investigate the risk levels of high-risk plaques with different numbers and combinations of high-risk features, using the pericoronary fat attenuation index （FAI） as a reference standard. Methods A total of 331 patients who underwent coronary CT angiography （CCTA） between September 2022 and June 2024 and had either high-risk or non-high-risk plaques in a single coronary artery were retrospectively enrolled. A total of 399 plaques were analyzed, including 289 high-risk plaques and 110 non-high-risk plaques. Patients were grouped based on the presence of high-risk features, the number and composition of these features, and the presence of spotty calcification or napkin-ring sign. The FAI surrounding the plaques was measured. Using the FAI value as a reference standard for assessing plaque risk, the optimal FAI threshold for identifying high-risk plaques was determined, and risk differences among plaques with varying high-risk features were compared. Finally, patients were followed up and the obtained results were externally validated. Results The optimal FAI threshold for identifying high-risk plaques was -74.5 HU. The FAI values of plaques containing two high-risk features were significantly lower than those of plaques containing three or four features （P < 0.05）. No significant difference was found between the three and four features groups（P > 0.05）. Plaques with low attenuation and positive remodeling showed significantly higher FAI values than those with spotty calcification and positive remodeling （P < 0.01）. The group with napkin-ring sign had significantly higher FAI values than those of the group without the napkin-ring sign（P < 0.05）. No significant difference in FAI was found between plaques with and without spotty calcification （P > 0.05）.The high-risk group exhibited a significantly higher FAI values （P < 0.001）. Notably, all MACE events occurred in the high-risk group, and the distribution of the low-density plaque plus positive remodeling feature and the napkin-ring sign feature also showed similar trends, all with statistical significance （P < 0.05）. Conclusion Combining the number and combination of high-risk features of coronary plaques allows for stratified assessment of the risk of acute coronary syndrome associated with plaques. -
图 4 4项高危特征
注： 低密度斑块合并正性重构、餐巾环征及点状钙化。FAI测量方法：选取目标斑块后，以斑块为中心设置矩形ROI：径向直径为血管外壁外扩5 mm，长度覆盖斑块两端管腔无狭窄处。由软件自动计算FAI值（Hu）。由1名心血管影像研究生在基线（第1周）进行测量2次并取平均值，间隔1周后（第2周）再次进行测量2次并取平均值，以2次平均值的均值作为测量结果。最终以第1周的平均值和第2周的平均值计算得到ICC为0.92，且P= 0.019。
Figure 4. Four high-risk features
图 6 随访病例
注：男性，57岁。CCTA提示冠状动脉LAD低密度斑块、点状钙化、餐巾环征及正性重构四种高危特征（箭头），斑块周围FAI值 -70HU。随访1年8个月后出现急性心肌梗死（ACS），并行PCI术后复查。
Figure 6. Follow-up cases
表 1 高危斑块与非高危斑块FAI（Hu）比较（$ \bar x \pm s $）
Table 1. Comparison of FAI（Hu） between high-risk plaques and non-high-risk plaques （$ \bar x \pm s $）
指标 FAI（Hu） 非高危斑块（n = 110） −79.25 ± 8.55 高危斑块（n = 289） −74.89 ± 6.86 t 5.289 P <0.001* *P < 0.05。 
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表 2 不同高危特征数量的高危斑块FAI（Hu）比较（$ \bar x \pm s $）
Table 2. Comparison of FAI（Hu）of high-risk plaques with different numbers of high-risk features （$ \bar x \pm s $）
特征数量 FAI 2项（n=184） −75.93 ± 6.59 3项（n=69） −73.36 ± 7.62∆ 4项（n=36） −72.50 ± 5.59∆ F 6.218 P 0.002* *P < 0.05；与2项特征组比较，∆P < 0.05。
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表 3 2种高危特征的斑块FAI（Hu）比较（$ \bar x \pm s $）
Table 3. Comparison of FAI （HU） among plaques with two high-risk features（$ \bar x \pm s $）
指标 FAI（Hu） 低密度+正性重构（n = 139） −74.98 ± 6.94a 点状钙化+正性重构（n = 35） −79.48 ± 3.93 低密度+点状钙化（n = 10） −76.60 ± 4.79 F 7.215 P 0.001* *P < 0.05；与点状钙化+正性重构组比较，aP < 0.05。
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表 4 3种高危特征的斑块FAI（Hu）比较（$ \bar x \pm s $）
Table 4. Comparison of FAI （Hu） among plaques with three high-risk features（$ \bar x \pm s $）
指标 FAI（Hu） FAI（Hu） −74.87 ± 5.65 低密度+点状钙化+正性重构（n = 23） −74.87 ± 5.65 餐巾环征+正性重构+低密度（n = 46） −72.61 ± 8.40 t −1.164 P 0.249
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表 5 有无餐巾环征的高危斑块FAI（Hu）比较（$ \bar x \pm s $）
Table 5. Comparison of FAI （Hu） of high-risk plaques with and without napkin ring sign（$ \bar x \pm s $）
指标 FAI （Hu） 有餐巾环征（n = 82） 72.56 ± 7.25 无餐巾环征（n = 207） −75.81 ± 6.49 t 3.709 P <0.001* *P < 0.05。
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表 6 有无点状钙化的高危斑块FAI（Hu）比较（$ \bar x \pm s $）
Table 6. Comparison of FAI （Hu） of high-risk plaques with and without spot calcification（$ \bar x \pm s $）
指标 FAI（Hu） 有点状钙化（n = 104） −75.77 ± 5.76 无点状钙化（n = 185） −74.39 ± 7.38 t −1.639 P 0.1
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表 7 不同FAI（Hu）/特征组合斑块风险分层的临床基线及随访结果比较
Table 7. Comparison of clinical baseline and follow-up outcomes of plaque risk stratification with different FAI（Hu）/feature combinations
变量 合计（n=90） 高危组（n = 30） 非高危组（n = 60） t/χ2 P 平均FAI（Hu） −79.79 ± 7.29 −72.24 ± 6.94 −81.61 ± 6.12 6.342 <0.001* MACE事件 8（8.89） 8（26.7） 0（0.00） 17.56 <0.001* 含低密度+正性重构 27（30.0） 27（90.0） 0（0.00） 77.14 <0.001* 含餐巾环征 9（10.0） 9（30.0） 0（0.00） 20.00 <0.001* *P < 0.05。
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