Improving Risk Stratification for Transient Ischaemic Attacks and Ischaemic Stroke in Patients with Coronary Artery Disease - A Combined Radiomics Analysis of Multimodal Adipose Tissue

Q: What was the goal of the study for patients with coronary artery disease?

To develop a comprehensive early warning risk assessment model for cerebral ischaemic events, including transient ischaemic attacks and ischaemic strokes, in this population.

Q: Which imaging data and radiomics elements were used to build the risk models?

The study used concurrent coronary CTA and cervical CTA, analyzed high-risk plaque characteristics, extracted radiomic features, and measured pericoronary fat attenuation index (FAI) and cervical perivascular fat density (PFD).

Sep 30, 2026

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Patients with combined cardiovascular and cerebrovascular disease experience worse outcomes, making early assessment of cerebral ischaemic risk crucial for guidance. A retrospective multicentre study recruited 326 coronary artery disease patients undergoing concurrent coronary CTA and cervical CTA, with follow-up for transient ischaemic attacks and ischaemic stroke. High-risk plaque features and radiomic signals from coronary and cervical arteries were analyzed, including pericoronary fat attenuation index and cervical perivascular fat density. Multivariate logistic regression confirmed RCA FAI and PFD as independent predictors, and the integrated Model 5 showed the best overall clinical benefit.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages18

Reading Time45 min

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Abstract

Introduction

Article Improving Risk Stratification for Transient Ischaemic Attacks and Ischaemic Stroke in Patients with Coronary Artery Disease: A Combined Radiomics Analysis of Multimodal Adipose Tissue Na Li 1,†, Shuting Wang 1,†, Hong Pan 1, Min Zhao 2, Jiali Sun 3, Wei Wang 3,* and Tong Zhang 1, * Academic Editor: Elad Asher Received: 29 October 2025 Revised: 27 December 2025 Accepted: 28 December 2025 Published: 1 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China; [linalinalinalinana@163.com](linalinalinalinana@163.com) (N.L.); [wangshuting1751@163.com](wangshuting1751@163.com) (S.W.); [pan15998390057@163.com](pan15998390057@163.com) (H.P.) 2 Pharmaceutical Diagnostics, GE Healthcare, Beijing 100176, China; [min.zhao@ge.com](min.zhao@ge.com) 3 The MRI Room, First Afliated Hospital of Harbin Medical University, Harbin 150001, China; sjl71801@163.com * Correspondence: [2447@hrbmu.edu.cn](2447@hrbmu.edu.cn) (W.W.); [yingxiang939@163.com](yingxiang939@163.com) (T.Z.)† These authors contributed equally to this work. Abstract Background/Objectives: Patients with combined cardiovascular and cerebrovascular disease face poorer prognoses. Early, accurate assessment of the risk of cerebral ischaemic events (including transient ischaemic attacks (TIAs) and ischaemic strokes (ISs)) in patients with coronary artery disease (CAD) is therefore vital for clinical guidance. This study aims to develop a comprehensive risk assessment model for early warning in this population. Methods: In this study, we conducted a retrospective multicentre recruitment of CAD patients undergoing concurrent coronary CTA and cervical CTA (n = 326), with follow-up to observe the occurrence of cerebral ischaemic events. We performed an analysis of high-risk plaque (HRP) characteristics and subcomponent plaque in coronary and cervical arteries, measured the pericoronary fat attenuation index (FAI) and cervical perivascular fat density (PFD), and extracted corresponding radiomic features. Five models were constructed to identify the CAD patients who developed IS/TIA, respectively: Model 1—clinical characteristics; Model 2—coronary CTA parameters + Radscorecoronary; Model 3—cervical CTA parameters + Radscore cervical; Model 4—Model 1 + Model 2; Model 5—Model 1 + Model 2 + Model 3 . Results: In the cerebral ischaemia group, the prevalence of coronary and/or cervical HRP was higher than in the non-ischaemia group (28.0% vs. 26.1%, 57.0% vs. 44.0%, p = 0.02) . Multivariate logistic regression confirmed that RCA FAI and PFD remained significant independent risk factors for IS/TIA (all p < 0.05) . The model prediction results showed that progressively incorporating coronary and cerebral vascular risk factors into the clinical features gradually improved model performance (Model 4 vs. Model 5, AUC: 0.711 [0.645–0.777] vs. 0.821 [0.769–0.873]) . Model 5 achieved a sensitivity of 0.788 [0.485–0.909] and specificity of 0.827 [0.385–0.923], demonstrating the best overall clinical benefit. Conclusions: RCA FAI and PFD are independent predictors of cerebral ischaemic events. By integrating clinical characteristics, coronary CTA and cervical CTA parameters, combined with Radscorecoronary and Radscore cervical, the risk stratification capability for IS/TIA in CAD patients can be significantly enhanced. Keywords: computed tomography angiography; FAI; PFD; radiomic features; perivascular adipose tissue; IS/TIA 1. Introduction Coronary atherosclerotic heart disease remains one of the leading causes of mortality and disability globally [1] . It is commonly attributed to myocardial ischaemia resulting from coronary atherosclerosis, often accompanied by the progression of systemic vascular dis

FAQs

What was the goal of the study for patients with coronary artery disease?

To develop a comprehensive early warning risk assessment model for cerebral ischaemic events, including transient ischaemic attacks and ischaemic strokes, in this population.

Which imaging data and radiomics elements were used to build the risk models?

The study used concurrent coronary CTA and cervical CTA, analyzed high-risk plaque characteristics, extracted radiomic features, and measured pericoronary fat attenuation index (FAI) and cervical perivascular fat density (PFD).

What predictors were identified for cerebral ischaemic events, and which model performed best?

RCA FAI and PFD remained significant independent risk factors for IS/TIA. Model 5, integrating clinical characteristics with both coronary and cervical CTA-derived features, achieved the best overall clinical benefit.

Sep 30, 2026

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