Association of Radiomics and Pericarotid Adipose Tissue Characteristics with Systemic Inflammation in Patients Undergoing Carotid Endarterectomy

<b>Background:</b> Pericarotid adipose tissue (PCAT) characteristics and systemic inflammation may play an important role in carotid endarterectomy (CEA) outcomes. This study explores the association between PCAT Hounsfield Unit (HU) ranges, radiomic features, and systemic inflammatory markers in patients undergoing carotid endarterectomy (CEA). <b>Methods:</b> Twenty patients undergoing CEA were included in this cross-sectional study. PCAT was analyzed using preoperative computed tomography angiography (CTA) images, with regions of interest defined around the carotid arteries. PCAT was categorized into three HU ranges: -190 to -120, -119 to -70, and -69 to -30. Radiomics features were extracted using PyRadiomics. The primary outcome was the correlation of PCAT imaging with preoperative neutrophil-to-lymphocyte ratios (NLRs). The secondary outcome was the association of PCAT imaging with the red cell distribution width (RDW-CV). Linear regression was used to evaluate associations between PCAT characteristics and inflammatory markers. <b>Results:</b> Distinct HU ranges in PCAT imaging showed strong correlations with the preoperative NLR. The -190 to -120 HU range demonstrated a negative association (β = -3.809, <i>p</i> < 0.001), whereas the -119 to -70 HU range showed a positive correlation (β = 3.814, <i>p</i> < 0.001). PCAT uniformity was positively associated with RDW-CV (β = 0.494, <i>p</i> = 0.027). Other radiomics features, such as contrast, showed trends but did not reach statistical significance. A larger outer area of PCAT was inversely associated with the NLR (β = -0.677, <i>p</i> < 0.001). <b>Conclusions:</b> Specific PCAT HU ranges and radiomics features are significantly associated with systemic inflammatory markers in CEA patients. These findings suggest that HU-based segmentation and radiomics analysis of PCAT may offer valuable insights into the relationship between local adipose tissue characteristics and systemic inflammation.