Objectives To investigate the relationship between metabolic syndrome (MetS), visceral adipose tissue (VAT), and high-risk coronary plaques. Materials and methods This study analyzed 392 hospitalized patients who underwent dual-energy computed tomography (DECT) for cardiac and abdominal imaging between May 2021 and February 2024. VAT multimodal attenuation parameters (CT40keV, CT70keV, λHU, and Eff-Z) were obtained at the third lumbar vertebral level. Multivariable logistic regression was performed to assess independent associations between VAT parameters and coronary high-risk plaques. Prediction models were established to predict the presence of high-risk plaques, and their predictive efficacy was evaluated by ROC analysis. Results MetS patients (n = 182) demonstrated a higher prevalence of high-risk plaques vs non-MetS (n = 210) (45.6% vs 25.7%, p < 0.001). DECT-derived VAT parameters were significantly lower in the MetS group than in the non-MetS group (p < 0.001). Moreover, CT40keV, CT70keV, λHU, and Eff-Z were correlated with the number of MetS components and each component, after adjusting for age and sex (p < 0.05). CT40keV was the strongest independent predictor for high-risk plaques in patients with MetS (standard partial regression coefficient Beta = −0.761, p < 0.001). In the predictive models for high-risk plaques, all models incorporating CT40keV demonstrated improved discriminative capability compared to traditional risk assessment approaches (standalone CACS or FRS), with AUC improvements ranging from Δ0.0729 to Δ0.205 (p < 0.05). Conclusions VAT was independently associated with the presence of high-risk coronary plaques in the MetS group, and DECT-derived CT40keV may be a potential biomarker for high-risk plaques. The prediction model incorporating CT40keV provides incremental value for predicting high-risk plaques. Critical relevance statement This study demonstrates that visceral fat CT40keV attenuation metrics derived from DECT are strongly associated with high-risk coronary plaques in MetS patients, offering a novel imaging biomarker for early cardiovascular risk stratification. Key Points <UnorderedList Mark="Bullet"> <ItemContent> MetS patients exhibited a significantly higher prevalence of high-risk plaques compared to non-MetS controls. </ItemContent> <ItemContent> Dual-energy CT-derived CT40keV was the independent predictor for high-risk plaques in patients with MetS. </ItemContent> <ItemContent> The prediction model incorporating CT40keV provides incremental value for predicting high-risk plaques. </ItemContent> </UnorderedList> Graphical Abstract

Associations of dual-energy computed tomography-derived visceral adipose tissue quality and high-risk coronary plaque in patients with metabolic syndrome

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2026年4月20日

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Yuxue Dang,
Weishi Ni,
Yanhua Zhen,
Xinyu Fu,
Wenyue Dou,
Yang Hou

摘要

Objectives

To investigate the relationship between metabolic syndrome (MetS), visceral adipose tissue (VAT), and high-risk coronary plaques.

Materials and methods

This study analyzed 392 hospitalized patients who underwent dual-energy computed tomography (DECT) for cardiac and abdominal imaging between May 2021 and February 2024. VAT multimodal attenuation parameters (CT_40keV, CT_70keV, λ_HU, and Eff-Z) were obtained at the third lumbar vertebral level. Multivariable logistic regression was performed to assess independent associations between VAT parameters and coronary high-risk plaques. Prediction models were established to predict the presence of high-risk plaques, and their predictive efficacy was evaluated by ROC analysis.

Results

MetS patients (n = 182) demonstrated a higher prevalence of high-risk plaques vs non-MetS (n = 210) (45.6% vs 25.7%, p < 0.001). DECT-derived VAT parameters were significantly lower in the MetS group than in the non-MetS group (p < 0.001). Moreover, CT_40keV, CT_70keV, λ_HU, and Eff-Z were correlated with the number of MetS components and each component, after adjusting for age and sex (p < 0.05). CT_40keV was the strongest independent predictor for high-risk plaques in patients with MetS (standard partial regression coefficient Beta = −0.761, p < 0.001). In the predictive models for high-risk plaques, all models incorporating CT_40keV demonstrated improved discriminative capability compared to traditional risk assessment approaches (standalone CACS or FRS), with AUC improvements ranging from Δ0.0729 to Δ0.205 (p < 0.05).

Conclusions

VAT was independently associated with the presence of high-risk coronary plaques in the MetS group, and DECT-derived CT_40keV may be a potential biomarker for high-risk plaques. The prediction model incorporating CT_40keV provides incremental value for predicting high-risk plaques.

Critical relevance statement

This study demonstrates that visceral fat CT_40keV attenuation metrics derived from DECT are strongly associated with high-risk coronary plaques in MetS patients, offering a novel imaging biomarker for early cardiovascular risk stratification.

Key Points

MetS patients exhibited a significantly higher prevalence of high-risk plaques compared to non-MetS controls.

Dual-energy CT-derived CT_40keV was the independent predictor for high-risk plaques in patients with MetS.

The prediction model incorporating CT_40keV provides incremental value for predicting high-risk plaques.

Graphical Abstract