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Purpose: To assess the association between nonalcoholic fatty liver disease (NAFLD) and quantitative atherosclerotic plaque at CT. Materials and Methods: In this post hoc analysis of the prospective Scottish Computed Tomography of the HEART trial (November 2010 to September 2014), hepatosteatosis and coronary artery calcium score were measured at noncontrast CT. Presence of stenoses, visually assessed high-risk plaque, and quantitative plaque burden were assessed at coronary CT angiography. Multivariable models were constructed to assess the impact of hepatosteatosis and cardiovascular risk factors on coronary artery disease. Results: Images from 1726 participants (mean age, 58 years ± 9 [SD]; 974 men) were included. Participants with hepatosteatosis (155 of 1726, 9%) had a higher body mass index, more hypertension and diabetes mellitus, and higher cardiovascular risk scores (P < .001 for all) compared with those without hepatosteatosis. They had increased coronary artery calcium scores (median, 43 Agatston units [AU] [interquartile range, 0-273] vs 19 AU [0-225], P = .046), more nonobstructive disease (48% vs 37%, P = .02), and higher low-attenuation plaque burden (5.11% [0-7.16] vs 4.07% [0-6.84], P = .04). However, these associations were not independent of cardiovascular risk factors. Over a median of 4.7 years, there was no evidence of a difference in myocardial infarction between those with and without hepatosteatosis (1.9% vs 2.4%, P = .92). Conclusion: Hepatosteatosis at CT was associated with an increased prevalence of coronary artery disease at CT, but this was not independent of the presence of cardiovascular risk factors.Keywords: CT, Cardiac, Nonalcoholic Fatty Liver Disease, Coronary Artery Disease, Hepatosteatosis, Plaque QuantificationClinical trial registration no. NCT01149590 Supplemental material is available for this article. © RSNA, 2022See also commentary by Abohashem and Blankstein in this issue.
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INTRODUCTION: Increased abdominal visceral fat has been shown to be a cardiovascular risk factor. Preliminary studies indicate that pericardiac fat (PF) may provide similar information. We aimed to develop new software (QFAT) for automatic quantitation of PF from noncontrast cardiac CT and compare PF measures to other cardiovascular risk factors. METHODS: QFAT accepts user-defined range of noncontrast transverse cardiac CT slices, automatically segments the heart, and determines PF volume (PFV) as contiguous pericardial fat voxels. PFV normalized to cardiac volume defines PF ratio (PFR). QFAT and manual processing (MAN) was performed in 105 patients (mean BMI, 27; range, 17-41) by 2 observers. RESULTS: Mean processing time was 20 +/- 4 seconds for QFAT, and 9 +/- 6 minutes for MAN. There was excellent agreement between QFAT and MAN for PFV (R = 0.98) and PFR (R = 0.98). MAN and QFAT interobserver variability were comparable. Interscan and interscanner variability for PFV and PFR were comparable to corresponding interobserver variability. PFV (R = 0.88, P < 0.0001) and PFR (R = 0.81, P < 0.0001) correlated strongly with abdominal visceral fat area, moderately with BMI (R = 0.58, P < 0.0001 and R = 0.48, P < 0.0001), and weakly with abdominal subcutaneous fat area (R = 0.33, P < 0.0001 and R = 0.32, P = 0.001). CONCLUSIONS: PFV and PFR can be accurately and automatically quantified from noncontrast CT acquired for coronary calcium screening and may provide complementary information regarding cardiovascular risk.