ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
This article is part of the Research TopicApplications and Advances of Artificial Intelligence in Medical Image Analysis: PET, SPECT/ CT, MRI, and Pathology ImagingView all 10 articles
Development of a new threshold for pericoronary fat attenuation based on 40 keV virtual monoenergetic images from dual-energy spectral CT
Provisionally accepted
- 1North Sichuan Medical College, Nanchong, China
- 2Chongqing General Hospital, Chongqing, China
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Adipose tissue exhibits distinct attenuation on 40 keV virtual monoenergetic images (VMI) from spectral detector CT (SDCT) compared to conventional mixed-energy images (MEI). While the pericoronary adipose tissue (PCAT) fat attenuation index (FAI) is typically derived from MEI, data on 40 keV VMI remain limited. We retrospectively analyzed 60 patients who underwent SDCT coronary angiography, selecting PCAT around the right coronary artery for FAI assessment. Within the same volume of interest, 40 keV VMI showed significantly lower minimum, mean, and median CT values (all P < 0.001), higher maximum values (−30 vs. 54.00 [28.25–89.75] HU), and broader CT value distribution than MEI. Background noise was similar between modalities, but signal-to-noise ratio (SNR) was significantly higher on 40 keV VMI (P < 0.001). The difference in mean CT attenuation was associated solely with photon energy (P < 0.001), independent of clinical factors. We established a novel linear regression equation and proposed a new threshold range for FAI at 40 keV VMI. These findings support the need for energy-specific FAI interpretation in spectral CT.
Keywords: spectral detector computed tomography (SDCT), conventional mixed-energy images (MEI), Virtual Monoenergetic Images (VMI), pericoronary adipose tissue (PCAT), fatattenuation index (FAI)
Received: 04 Aug 2025; Accepted: 05 Nov 2025.
Copyright: © 2025 Chen, Zhou, Gu and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Min Gu, gumin1979@cqu.edu.cn
Kang Li, lkrmyydoctor@126.com
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