Table 4 Open in new tab Imaging...

Modality

Measurements characteristics

Strengths

Limitations

Echocardiography

EAT thickness

✓ Clinical availability
✓ Low cost
✓ Lack of radiation exposure
✓ Ease of use
✓ Safe

No PVAT assessment
Lack of reproducibility
Low/intermediate spatial resolution
No 3D analysis/volumetric data
No qualitative analysis
Can image only epicardial or subcutaneous fat but not PVAT
Lack of experience
Image quality is dependent on subject characteristics

Computed tomography

EAT thickness, area, volume, attenuation & quality, i.e. peri-vascular FAI, peri-vascular fat radiomic profile

✓ PVAT assessment
✓ Clinical availability
✓ Reproducibility
✓ Excellent spatial resolution
✓ Easy to perform
✓ Quantitative and qualitative data
✓ 3D volume data
✓ Incorporation of AI and machine learning algorithms
✓ Simultaneous assessment of coronary calcium and coronary plaque

Intermediate cost
Iodine contrast use
Radiation exposure

Magnetic resonance imaging

EAT thickness, area, volume proton density fat fraction

✓ Lack of radiation exposure
✓ Reproducibility
✓ Quantitative and qualitative data
✓ 3D volume data
✓ Simultaneous assessment of myocardial structure and function

PVAT assessment for large arteries like the aorta/carotids only, not the coronaries
Lack of availability
Intermediate/high cost
Intermediate spatial resolution (inferior to CT)
Time consuming

Positron emission tomography

SUV, TBR

✓ Gold standard to assess tissue inflammation by imaging

Cannot be used to image EAT or PVAT
High cost
Limitedavailability
Radiation exposure

Table 4

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Imaging modalities to assess adipose tissue

Modality	Measurements characteristics	Strengths	Limitations
Echocardiography	EAT thickness	✓ Clinical availability ✓ Low cost ✓ Lack of radiation exposure ✓ Ease of use ✓ Safe	No PVAT assessment Lack of reproducibility Low/intermediate spatial resolution No 3D analysis/volumetric data No qualitative analysis Can image only epicardial or subcutaneous fat but not PVAT Lack of experience Image quality is dependent on subject characteristics
Computed tomography	EAT thickness, area, volume, attenuation & quality, i.e. peri-vascular FAI, peri-vascular fat radiomic profile	✓ PVAT assessment ✓ Clinical availability ✓ Reproducibility ✓ Excellent spatial resolution ✓ Easy to perform ✓ Quantitative and qualitative data ✓ 3D volume data ✓ Incorporation of AI and machine learning algorithms ✓ Simultaneous assessment of coronary calcium and coronary plaque	Intermediate cost Iodine contrast use Radiation exposure
Magnetic resonance imaging	EAT thickness, area, volume proton density fat fraction	✓ Lack of radiation exposure ✓ Reproducibility ✓ Quantitative and qualitative data ✓ 3D volume data ✓ Simultaneous assessment of myocardial structure and function	PVAT assessment for large arteries like the aorta/carotids only, not the coronaries Lack of availability Intermediate/high cost Intermediate spatial resolution (inferior to CT) Time consuming
Positron emission tomography	SUV, TBR	✓ Gold standard to assess tissue inflammation by imaging	Cannot be used to image EAT or PVAT High cost Limitedavailability Radiation exposure

Modality	Measurements characteristics	Strengths	Limitations
Echocardiography	EAT thickness	✓ Clinical availability ✓ Low cost ✓ Lack of radiation exposure ✓ Ease of use ✓ Safe	No PVAT assessment Lack of reproducibility Low/intermediate spatial resolution No 3D analysis/volumetric data No qualitative analysis Can image only epicardial or subcutaneous fat but not PVAT Lack of experience Image quality is dependent on subject characteristics
Computed tomography	EAT thickness, area, volume, attenuation & quality, i.e. peri-vascular FAI, peri-vascular fat radiomic profile	✓ PVAT assessment ✓ Clinical availability ✓ Reproducibility ✓ Excellent spatial resolution ✓ Easy to perform ✓ Quantitative and qualitative data ✓ 3D volume data ✓ Incorporation of AI and machine learning algorithms ✓ Simultaneous assessment of coronary calcium and coronary plaque	Intermediate cost Iodine contrast use Radiation exposure
Magnetic resonance imaging	EAT thickness, area, volume proton density fat fraction	✓ Lack of radiation exposure ✓ Reproducibility ✓ Quantitative and qualitative data ✓ 3D volume data ✓ Simultaneous assessment of myocardial structure and function	PVAT assessment for large arteries like the aorta/carotids only, not the coronaries Lack of availability Intermediate/high cost Intermediate spatial resolution (inferior to CT) Time consuming
Positron emission tomography	SUV, TBR	✓ Gold standard to assess tissue inflammation by imaging	Cannot be used to image EAT or PVAT High cost Limitedavailability Radiation exposure

3D, three-dimensional; AI, artificial intelligence; CT, computed tomography; EAT, epicardial adipose tissue; FAI, fat attenuation index; PVAT, peri-vascular adipose tissue; SUV, standardized uptake values; TBR, target-to-background ratio.

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