CCTA Identifies Plaque Associated with Liver Disease

Coronary computed tomography angiography (CCTA) can help physicians detect advanced high-risk coronary plaque associated with nonalcoholic fatty liver disease (NAFLD), according to a study published in the journal Radiology.

Researchers from the United States and Austria sought to determine the association between NAFLD and the presence of high risk coronary atherosclerotic plaque as assessed with coronary CT angiography.

A total of 501 patients who had chest pain and a clinical suspicion of acute coronary syndrome were enrolled in the study. The patients underwent both non-enhanced CT to assess coronary calcium, and contrast-enhanced CCTA.

The coronary CT angiography images were read by three experienced core laboratory readers, who were looking for the presence of coronary plaque, significant stenosis (50% or higher), and high-risk plaque features (positive remodeling, CT attenuation, 30 HU, napkin-ring sign, spotty calcium).[[{"type":"media","view_mode":"media_crop","fid":"29130","attributes":{"alt":"axial nonenhanced CT image","class":"media-image media-image-right","id":"media_crop_8366140239041","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3012","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 166px; width: 275px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Axial nonenhanced CT image in a 62-year-old man demonstrates attenuation measurements of the liver and spleen. Image shows a diffuse fat accumulation in the liver, with a mean liver attenuation of 32.5 HU and a mean spleen attenuation of 46.2 HU. Image provided courtesy of Radiology. ©RSNA, 2014.","typeof":"foaf:Image"}}]]

The researchers found that 182 (40.9%) of 445 patients had CT evidence of NAFLD. High-risk plaque was more frequent in patients with NAFLD (59.3%) than in patients without NAFLD (19.0%), the authors noted. The association between NAFLD and high-risk plaque persisted after adjusting for the extent and severity of coronary atherosclerosis and traditional risk factors.

“The clinical implications could include a wider assessment of NAFLD using the non-contrast cardiac CT scans that are commonly performed prior to the CTA,” lead author Stefan B. Puchner, MD, said in a release. “Further, the additional assessment of NAFLD with CT could improve the risk stratification of patients with suspected coronary artery disease, as our results show that the presence of NAFLD is associated with high-risk coronary plaque independent of traditional risk factors and severity of coronary artery disease.”