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Features of pericoronary adipose tissue (PCAT) assessed from coronarycomputed tomography angiography (CCTA) are associated with inflammation andcardiovascular risk. As PCAT is vascularly connected with coronary vasculature,the presence of iodine is a potential confounding factor on PCAT HU andtextures that has not been adequately investigated. Use dynamic cardiac CTperfusion (CCTP) to inform contrast determinants of PCAT assessment. From CCTP,we analyzed HU dynamics of territory-specific PCAT, myocardium, and otheradipose depots in patients with coronary artery disease. HU, blood flow, andradiomics were assessed over time. Changes from peak aorta time, Pa, chosen tomodel the time of CCTA, were obtained. HU in PCAT increased more than in otheradipose depots. The estimated blood flow in PCAT was ~23% of that in thecontiguous myocardium. Comparing PCAT distal and proximal to a significantstenosis, we found less enhancement and longer time-to-peak distally.Two-second offsets [before, after] Pa resulted in [ 4-HU, 3-HU] differences inPCAT. Due to changes in HU, the apparent PCAT volume reduced ~15% from thefirst scan (P1) to Pa using a conventional fat window. Comparing radiomicfeatures over time, 78% of features changed >10% relative to P1. CCTPelucidates blood flow in PCAT and enables analysis of PCAT features over time.PCAT assessments (HU, apparent volume, and radiomics) are sensitive toacquisition timing and the presence of obstructive stenosis, which may confoundthe interpretation of PCAT in CCTA images. Data normalization may be in order.

Cardiac CT perfusion imaging of pericoronary adipose tissue (PCAT) highlights potential confounds in coronary CTA