Age‐, Body Surface Area‐, and Sex‐Specific Reference Values for Pericardial Adipose Tissue in Children: An MRI Study

ABSTRACT Background Pericardial adipose tissue (PAT) is a cardiovascular disease risk factor in children, but normative data for PAT thickness, area, and volume are lacking. Purpose To establish the percentile reference values for MRI PAT parameters in healthy Chinese children aged 3–18. Study Type Prospective. Subjects 218 healthy children divided into 3–10 years ( n = 125, 62 males) and 10–18 years ( n = 93, 53 males). Field Strength/Sequence Balanced steady‐state free‐precession cine sequence at 3.0 T. Assessment PAT thickness, area and volume. Statistical Tests Student's t ‐test, Mann–Whitney U test, Pearson correlation, the generalized additive model for location scale and shape, and intraclass correlation coefficients (ICC). A p value < 0.05 was considered statistically significant. Results PAT volume showed no significant sex difference in the overall (boys: 32.7 ± 16.2 mL, girls: 28.2 ± 10.0 mL, p = 0.179) or childhood group (boys: 22.9 ± 7.9 vs. girls: 22.9 ± 6.6 mL, p = 0.954), but adolescent boys had a higher volume than girls (44.1 ± 15.9 vs. 36.9 ± 8.4 mL). PAT thickness at the right ventricular free wall ( RVFW ) was greater in boys across both age groups. PAT volume correlated strongly with age ( r = 0.672) and BSA ( r = 0.741). Age‐specific percentile curves showed a progressive PAT volume increase with no clear plateau, with the most rapid growth between ages 10 and 14. BSA ‐specific curves revealed gradual PAT parameter increases, with steeper trends in boys. Good to excellent inter‐ and intra‐observer agreement was observed for almost all PAT parameter measurements (95% CI > 0.75). Conclusion This study proposes sex‐, age‐, and BSA ‐specific reference values for pericardial adipose tissue in healthy Chinese children and showed developmental patterns and sex differences that may have potential to inform future clinical and research applications. Evidence Level 2. Technical Efficacy Stage 2.