Local large arterial perivascular adipose tissue metabolic and anatomical features are associated with hypertensive clinical outcomes: a PET/CT-based study.

OBJECTIVE: This study investigated the relationship between anatomical and metabolic characteristics of large arterial perivascular adipose tissue (PVAT) and hypertensive clinical outcomes using positron emission tomography-computed tomography (PET/CT). METHODS: We analysed pretreatment 18F-FDG PET/CT data from 150 primary lung malignancies patients (age 65 ± 11 years; 45 hypertensive patients). The hypertension status at the time of PET/CT was recorded as the clinical outcome. The deep learning tool TotalSegmentator was used to segment large arteries in PET/CT images. The segmented large arteries included the common carotid arteries, subclavian arteries, brachiocephalic trunk, aorta, iliac arteries and pulmonary veins. Then, large arterial PVAT metabolism and anatomical features were extracted. These features were categorized as localized (e.g. left iliac arterial PVAT features, and PVAT features obtained after segmenting thoracic/abdominal aortic PVAT based on vertebral anatomical landmarks) or whole-body (the total volume and SUVmedian of PVAT around the aforementioned large arteries). The relationship between PVAT features and hypertensive outcomes was explored by correlation analysis and multivariate analysis. RESULTS: Whole-body large arterial PVAT volume and SUVmedian showed no significant differences across hypertensive outcomes, whereas localized large arterial PVAT features showed significant differences. T11 segment aortic PVAT volume (odds ratio [OR] = 1.238 [95% CI: 1.066, 1.437]; p = 0.005) and SUV90th-percentile of left iliac arterial PVAT ([OR] = 5.051 [95% CI: 1.378, 18.510]; p = 0.015) were higher in hypertensive patients. T5 segment aortic PVAT 90th percentile HU values and SUV90th-percentile can determine antihypertensive drug sensitivity (AUC = 0.85; 95% CI:0.71-0.98). Complication rates rose with declining SUV in T6 segment aortic PVAT ([OR] = 0.007 [95% CI: 0.000, 0.450]; p = 0.019). CONCLUSIONS: This study confirms the close relationship between the anatomical and metabolic characteristics of localized large arterial PVAT and hypertensive outcomes, and reveals its spatial enrichment pattern during disease progression.