Assessing the Parameter—Vessel-to-Lesion-Specific Perivascular Fat Attenuation Ratio, as a New Imaging Marker of High Risk Plaques

Abstract The perivascular fat attenuation has emerged as a novel imaging biomarker of coronary artery inflammation in recent years. The present study assessed the role of lesion-specific perivascular fat attenuation (l-PVFA) and vessel-to-l-PVFA ratio (v/l- PVFAR) in plaque characterization and identifying the vulnerable/high risk plaques (HRPs) using computed tomography (CT) coronary angiogram. (1) To establish the significance of l-PVFA and v/l- PVFAR in the characterization of different types of plaques. (2) v/l PVFAR as a new imaging marker in the identification of HRPs. Thirty participants underwent CT coronary angiogram and we studied 70 diseased coronary arteries in these patients. Out of the 70 plaques studied retrospectively, 40 were calcified, 23 were partially calcified, and 7 were noncalcified plaques. l-PVFA and v/l PVFAR were calculated manually for different types of plaques and found significantly higher in noncalcified and partially calcified plaques, when compared with calcified plaques (p < 0.001). v/l PVFAR of > 2 is highly sensitive (100%) and specific (95.2%) for HRP with the diagnostic accuracy of 96.67%. l-PVFA and v/l PVFAR highly correlate with various types of plaques. v/l- PVFAR is a useful biomarker in the identification of HRPs.