European Radiology

, Volume 29, Issue 2, pp 932–940 | Cite as

Is the epicardial adipose tissue area on non-ECG gated low-dose chest CT useful for predicting coronary atherosclerosis in an asymptomatic population considered for lung cancer screening?

  • Kyu-Chong Lee
  • Hwan Seok YongEmail author
  • Jaewook Lee
  • Eun-young Kang
  • Jin Oh Na



The purpose was to determine whether the epicardial adipose tissue (EAT) area on low-dose chest CT (LDCT) could be used to predict coronary atherosclerosis in an asymptomatic population considered for lung cancer screening.


Subjects aged 55-80 years with smoking history who underwent both LDCT and coronary CT angiography (CCTA) were retrospectively enrolled. Correlation between the EAT volume in CCTA and EAT area in LDCT was evaluated. Coronary risk factors including the body surface area (BSA) indexed EAT area were compared between coronary plaque negative and positive groups. Significant factors for predicting coronary atherosclerosis were analyzed with logistic regression analysis. Receiver-operating characteristic curve analysis was performed to determine the cutoff value.


A total of 438 subjects were enrolled, including 299 subjects with coronary atherosclerosis. There was a good correlation between the EAT volume in CCTA and EAT area in LDCT (ρ = 0.712, p < 0.001). There were significant differences in age, systolic blood pressure, all BSA indexed EAT area, sex, and hypertension between plaque negative and positive groups. In multivariate logistic regression for the BSA indexed EAT area in LDCT at the RCA level, sex (OR: 11.168, 95% CI: 2.107-59.201, p = 0.005), systolic blood pressure (OR: 1.021, 95% CI: 1.005-1.036, p = 0.009), hypertension (OR: 1.723, 95% CI: 1.103-2.753, p = 0.017), and EAT area (OR: 1.273, 95% CI: 1.154-1.405, p < 0.001) were significant. The area under the curve of the BSA indexed EAT area in LDCT at the RCA level for coronary atherosclerosis was 0.657, and the cut-off value was 7.66 cm2/m2.


The EAT area in LDCT could be used to predict coronary atherosclerosis in an asymptomatic population considered for lung cancer screening.

Key Points

• To quantify EAT, the EAT area in LDCT can be used instead of the EAT volume in CCTA.

• The EAT area measured in LDCT can be used as a predictor of coronary artery disease.

• The extensive CAD group tended to have a greater EAT area than the non-extensive CAD group.


Coronary artery disease Pericardium Adipose tissue Computed tomography angiography Multidetector computed tomography 

Abbreviations and acronyms


EAT area in CCTA


EAT area in LDCT


EAT area in LDCT at LM


EAT area in LDCT at RCA


Area under the curve


Body mass index


Body surface area


Coronary artery disease


Coronary CT angiography


Confidence intervals


Computed tomography


Diastolic blood pressure


Epicardial adipose tissue


High-density lipoprotein


Hounsfield units


Institutional Review Board


Low-dose chest computed tomography


Low-density lipoprotein


Left main coronary artery


Myocardial infarction


Magnetic resonance imaging


National Lung Screening Trial


Odds ratios (ORs)


Right coronary artery


Receiver-operating characteristic


Systolic blood pressure


US Preventive Services Task Force


EAT volume in CCTA



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Hwan Seok Yong.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Case-control study

• Performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Kyu-Chong Lee
    • 1
  • Hwan Seok Yong
    • 1
    • 2
    Email author
  • Jaewook Lee
    • 1
  • Eun-young Kang
    • 1
  • Jin Oh Na
    • 3
  1. 1.Departments of Radiology, College of MedicineKorea UniversitySeoulKorea
  2. 2.Korea University Guro HospitalSeoulKorea
  3. 3.Departments of cardiology, College of MedicineKorea UniversitySeoulKorea

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