Carotid perivascular fat attenuation on CT angiography as an imaging biomarker for inflammation in carotid atherosclerosis: a systematic review and meta-analysis
Abstract
Aims
Carotid atherosclerosis is a leading cause of ischemic stroke, driven by plaque inflammation. While current carotid imaging focuses on luminal stenosis, quantitative perivascular adipose tissue attenuation (PVAT) on computed tomography angiography has emerged as a potential non-invasive biomarker for arterial inflammation and plaque instability in coronary arteries. This systematic review and meta-analysis consider the utility of PVAT for imaging and risk-stratifying inflamed and vulnerable carotid atherosclerotic plaques.
Methods and Results
Following PRISMA guidelines, a systematic literature search identified 11 studies suitable for meta-analysis, incorporating 2316 patients. We compared continuous PVAT measures between symptomatic and asymptomatic carotid arteries using mean differences and 95% confidence intervals, employing a random-effects meta-analysis due to substantial heterogeneity (I² = 92%). The pooled mean difference (MD) was 12.63 HU (95% CI: 8.39-16.88), indicating significantly higher PVAT in symptomatic arteries. While funnel plot asymmetry was visually observed, Egger’s test (intercept = 7.29, p = 0.044) confirmed statistically significant publication bias, highlighting the need to apply caution when interpreting the results given the high heterogeneity. Notably, the leave-one-out sensitivity analysis showed no significant change in the overall p-value or substantial shifts in statistical heterogeneity.
Conclusion
This meta-analysis supports PVAT as a promising non-invasive imaging marker for inflammation and vulnerable plaques in symptomatic carotid atherosclerosis. The findings, while subject to heterogeneity and requiring further validation against conflicting individual study results, suggest a possible role of carotid PVAT for risk stratification. Future directions may PVAT use for monitoring treatment response in clinical trials.
Related articles
Related articles are currently not available for this article.