Research on Risk Assessment of High-risk Plaque Risk Based on Pericoronary Fat Quantification via CCTA

Saiyue WU; Hui DUAN; Dan HAN

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Saiyue WU, Hui DUAN, Dan HAN. Research on Risk Assessment of High-risk Plaque Risk Based on Pericoronary Fat Quantification via CCTA[J]. Journal of Kunming Medical University.

Citation:

Saiyue WU, Hui DUAN, Dan HAN. Research on Risk Assessment of High-risk Plaque Risk Based on Pericoronary Fat Quantification via CCTA[J]. Journal of Kunming Medical University.

Saiyue WU, Hui DUAN, Dan HAN. Research on Risk Assessment of High-risk Plaque Risk Based on Pericoronary Fat Quantification via CCTA[J]. Journal of Kunming Medical University.

Citation:

Saiyue WU, Hui DUAN, Dan HAN. Research on Risk Assessment of High-risk Plaque Risk Based on Pericoronary Fat Quantification via CCTA[J]. Journal of Kunming Medical University.

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Research on Risk Assessment of High-risk Plaque Risk Based on Pericoronary Fat Quantification via CCTA

Saiyue WU¹,
Hui DUAN²,
Dan HAN^{2
,
,}

1.
Yunnan Maternal and Child Health Care Hospital，Kunming Yunnan 650200
2.
Department of Medical Imaging，The First Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650100，China

Received Date: 2026-02-26

Abstract

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.
- Coronary CT angiography,
- Fat attenuation index,
- High-risk plaque,
- Risk stratification,
- Acute coronary syndrome

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