Computed Tomography Imaging of Epicardial Adipose Tissue

Computed tomography (CT) assessment of epicardial adipose tissue (EAT) is considered the gold standard, especially for research purposes. Using semiautomated three-dimensional quantification, non-contrast- or contrast-enhanced cardiac CT imaging allows for reliable assessment of both epicardial adipose tissue volume and attenuation. Once, CT imaging is performed, information of epicardial fat is readily available. There is overwhelming data on the strong association of CT-derived EAT volume with traditional cardiovascular risk factors, presence and progression of coronary atherosclerosis, and coronary artery disease manifestation. In addition to EAT volume, CT-derived fat attenuation has gained interest, as it reflects metabolic and inflammatory activity of this visceral fat depot. Besides overall EAT, also peri-coronary fat as its component directly surrounding the coronary arteries shows an even more distinct link with disease manifestation, supporting the hypothesis of a local impact of visceral adipose tissue on atherosclerosis development in the underlying vasculature. This book chapter gives an overview over the existing literature, described methods for quantification of EAT using CT imaging of the heart, and provides a perspective of data we might expect in this field in the future.