DOI: 10.1161/jaha.126.051823 ISSN: 2047-9980

Computed Tomography–Based Periaortic Adipose Tissue Imaging Phenotypes in Type B Aortic Dissection: A Retrospective Case–Control Study

Hao‐jie Lei, Guang‐ren Huang, Xing‐ning Mao, Zhong Qin, Xiao Qin, Jing Chen, Hai‐ying Zhang, Zi‐san Zeng, Qian‐hui Tang
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Background

The periaortic microenvironment visible on routine computed tomography angiography remains incompletely characterized in type B aortic dissection (TBAD). We evaluated computed tomography angiography–based periaortic adipose tissue (PAAT) phenotypes associated with prevalent TBAD and explored a prespecified Tear Risk Index for post–thoracic endovascular aortic repair aortic dilation.

Methods

This retrospective case–control study included 100 patients with TBAD undergoing primary thoracic endovascular aortic repair and 50 normal controls frequency matched by age and sex. Deep learning–assisted, radiologist‐reviewed segmentation quantified multilayer PAAT and aortic morphology. Interreader reproducibility was assessed using intraclass correlation coefficients and Bland–Altman analyses. Group comparisons, receiver operating characteristic analyses, and adjusted logistic regression were performed.

Results

Compared with controls, patients with TBAD had larger aortic volume and higher 3‐mm PAAT volume, fat attenuation index, and fragmentation index. Aortic volume showed an area under the curve of 0.966 (95% CI, 0.941–0.991); corresponding values for 3‐mm PAAT volume, fat attenuation index, and fragmentation index were 0.614, 0.819, and 0.716, respectively. Interreader intraclass correlation coefficients for selected 3‐mm PAAT measures ranged from 0.822 to 0.907. Principal TBAD‐control PAAT findings remained supported after false discovery rate correction, whereas post–thoracic endovascular aortic repair PAAT differences were not robust. Tear Risk Index showed limited exploratory discrimination for dilation status.

Conclusions

Selected 3‐mm PAAT measures characterize a reproducible computed tomography angiography–based imaging phenotype associated with prevalent TBAD and may complement conventional aortic morphology. These findings are hypothesis generating, and Tear Risk Index should not be used as a standalone clinical predictor.

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