Multi-parametric Algorithm for Epicardial Adipose Tissue Quantification in Patients with Non-Ischemic Heart Disease

Epicardial adipose tissue (EAT), an active endocrine and paracrine organ, contributes to cardiovascular pathogenesis. While cardiac magnetic resonance (CMR) is the reference standard for quantifying EAT volume (EATV), its clinical utility is limited. Non-contrast chest CT (NCCT), widely used in radiology, offers a potential alternative. Although coronary CT angiography (CCTA) improves EAT-myocardial border delineation, its use is restricted by contrast allergy risks and increased radiation exposure. This study investigates the feasibility of NCCT for EATV assessment compared to CMR. We enrolled 120 non-ischemic heart disease patients undergoing both NCCT and CMR during a single hospitalization. EATV was measured using CMR-based volumetric analysis and NCCT-based grayscale threshold segmentation. EAT thickness was quantified at six anatomical sites (left/right atrioventricular grooves, anterior/posterior/superior interventricular grooves, and right ventricular free wall) on both modalities. Statistical analysis compared volume and thickness measurements. EATV derived from NCCT threshold segmentation showed no significant difference compared to CMR volumetry (P> 0.05). Similarly, EAT thickness measurements across all six sites demonstrated no significant differences between NCCT and CMR (all P> 0.05). NCCT-based grayscale threshold segmentation provides EATV measurements comparable to the CMR reference standard. This validates NCCT as a rapid, cost-effective, and clinically feasible alternative for accurate EAT quantification.