Perivascular Epicardial Fat Stranding at Coronary CT Angiography: A Marker of Acute Plaque Rupture and Spontaneous Coronary Artery Dissection

Authors:
Publisher website
Google Scholar
Abstract
Our study describes perivascular epicardial fat stranding, which has the potential to improve the detection of higher-risk patients with coronary atherosclerosis or can act as a marker of a non-atherosclerotic cause of stenosis (ie, spontaneous coronary artery dissection [SCAD]). Perivascular fat stranding was seen in 5% of low-to-intermediate pretest risk patients found to have moderate or higher degrees of stenosis (Coronary Artery Disease Reporting and Data System [CAD-RADS] 3–5) and was seen less commonly along with the classic high-risk plaque features (vulnerable plaque, CAD-RADS modifier V). Recognition of perivascular fat stranding may be helpful in identifying culprit lesion, SCAD, and patients at elevated risk for acute coronary syndrome. Purpose To evaluate the frequency and implications of perivascular fat stranding on coronary computed tomography (CT) angiograms obtained for suspected acute coronary syndrome (ACS). Materials and Methods This retrospective registry study was approved by the institutional review board. The authors reviewed the medical records and images of 1403 consecutive patients (796 men, 607 women; mean age, 52.8 years) who underwent coronary CT angiography at the emergency department from February 2012 to March 2016. Fat attenuation, length and number of circumferential quadrants of the affected segment, and attenuation values in the unaffected epicardial and subcutaneous fat were measured. “Cases” were defined as patients with perivascular fat stranding. Patients with significant stenosis but without fat stranding were considered control subjects. Baseline imaging characteristics, ACS frequency, and results of subsequent downstream testing were compared between cases and control subjects by using two-sample t, Mann-...

This publication has 34 references indexed in Scilit: