Pericoronary adipose tissue radiomics from coronary CT angiography identifies vulnerable plaques characteristics in intravascular OCT

Pericoronary adipose tissue (PCAT) features on CT have been shown to reflect local inflammation, and signals increased cardiovascular risk. Our goal was to determine if PCAT radiomics extracted from coronary CT angiography (CCTA) images are associated with intravascular optical coherence tomography (IVOCT)-identified vulnerable plaque characteristics (e.g., microchannels [MC] and thin-cap fibroatheroma [TCFA]). CCTA and IVOCT images of 30 lesions from 25 patients were registered. Vessels with vulnerable plaques were identified from the registered IVOCT images. PCAT radiomics features were extracted from CCTA images for the lesion region of interest (PCAT-LOI) and the entire vessel (PCAT-Vessel). We extracted 1356 radiomics features, including intensity (first-order), shape, and texture features. Features were reduced using standard approaches (e.g., high feature correlation). Using stratified three-fold cross-validation with 1000 repeats, we determined the ability of PCAT radiomics features from CCTA to predict IVOCT vulnerable plaque characteristics. In identification of TCFA lesions, PCAT-LOI and PCAT-Vessel radiomics models performed comparably (AUC±standard deviation 0.78±0.13, 0.77±0.14). For identification of MC lesions, PCAT-Vessel radiomics model (0.89±0.09) was moderately better associated than that of PCAT-LOI model (0.83±0.12). Both PCAT-LOI and PCAT-Vessel radiomics models also similarly identified coronary vessels thought to be highly vulnerable (i.e., both TCFA and MC) (0.88±0.10, 0.91±0.09). Favorable radiomics features tended to be those describing texture and size of PCAT. PCAT radiomics can identify coronary vessels with TCFA or MC, consistent with IVOCT. CCTA radiomics may improve risk stratification by noninvasively detecting vulnerable plaque characteristics that are only visible with IVOCT. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the National Science Foundation Graduate Research Fellowship under Grant No 1937968. This project was also supported by the National Heart, Lung, and Blood Institute through grants NIH R21 HL108263, NIH R01 HL114406, and NIH R01 HL143484. This research was conducted in space renovated using funds from an NIH construction grant (C06 RR12463) awarded to Case Western Reserve University. The veracity guarantor, Juhwan Lee, affirms to the best of his knowledge that all aspects of this paper are accurate. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This retrospective study was approved by the Institutional Review Board of University Hospitals Cleveland Medical Center (Cleveland, OH, USA), conducted following the principles of the Declaration of Helsinki, and the written consent was waived. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.