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Authors address inclusion of visceral fat area (VFA) quantification as a way to reduce obesity confounding, discuss expanding modeling using LASSO/penalized regression for more variables, and emphasize reproducibility through visualization. They highlight TotalSegmentator-based whole-body vascular segmentation and propose future multiplanar reconstruction or maximum intensity projection with color-coded arterial annotations to improve clarity and clinical translation of PVAT imaging biomarkers.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/response-to-letter-regarding-local-large-arterial-perivascular-adipose-tissue-metabolic-and-anatomical-features-are-associated-with-hypertensive-clinical-outcomes-a-petct-based-study/449341/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/response-to-letter-regarding-local-large-arterial-perivascular-adipose-tissue-metabolic-and-anatomical-features-are-associated-with-hypertensive-clinical-outcomes-a-petct-based-study/449341.png","ImageObject",300,407,{"name":92,"@type":93},"Blitz","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-06","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main purpose of this letter to the editor?","Question",{"text":112,"@type":113},"To respond to authors’ comments on a PET/CT-based study examining vertebra-level PVAT assessment and its association with hypertensive clinical outcomes.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How do the authors address the suggestion about quantifying visceral fat area (VFA)?",{"text":117,"@type":113},"They agree that adding VFA measurements on CT images, such as at the L3 level, could improve analysis by better accounting for PVAT plasticity influenced by central obesity, diet, or physical activity.",{"name":119,"@type":110,"acceptedAnswer":120},"What future methodological improvements do the authors propose?",{"text":121,"@type":113},"They plan more extensive LASSO analyses to verify feature selection reliability and suggest adding multiplanar reconstruction or maximum intensity projection images with color-coded major artery annotations to enhance methodological clarity and reproducibility.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},449341,1791296278,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24},24464137899374,"https://us-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","AnnAls of Medicine  \n2026, Vol. 58, no. 1, 2612798  \n[https://doi.org/10.1080/07853890.2026.2612798](https://doi.org/10.1080/07853890.2026.2612798)  \nLETTER TO THE EDITOR     \nResponse to letter regarding ‘local large arterial perivascular adipose tissue metabolic and anatomical features are associated with hypertensive clinical outcomes: a PET/CT-Based study’  \nDear Editor,  \nWe sincerely appreciate the authors’ thoughtful comments and valuable suggestions regarding our study on vertebra-level assessment of perivascular adipose tissue (PVAT) [1–2] . We are also grateful for their recognition of the study’s innovation and its potential clinical value. In response to the points they have raised, our replies are as follows.  \nWe acknowledge that directly quantifying visceral fat area (VFA) allows for a more precise control of obesity-related confounding factors. Although VFA measurements were not included in the present study, we fully agree that assessing VFA on CT images, such as at the L3 vertebral level, could enhance analytical accuracy and better account for the plasticity of PVAT influenced by central obesity, diet, or physical activity. This represents an important direction for future research.  \nWe appreciate the suggestion regarding the use of LASSO regression to complement univariable screening. In our study, the number of features included in the final model was relatively modest, and the risk of overfitting was carefully evaluated. Nonetheless, we agree that when dealing with a larger number of variables, LASSO or other penalized regression approaches can further enhance model robustness. In future work, we plan to incorporate LASSO analyses more extensively to verify the reliability of the feature selection process and improve the model’s generalizability.  \nWe agree that clear visualizations are essential for improving methodological reproducibility and understanding. The use of TotalSegmentator for whole-body vascular segmentation is indeed a key methodological strength of the study. In future work, multiplanar reconstruction (MPR) or maximum intensity projection (MIP) images with color-coded annotations of major arteries, such as the carotid, subclavian, aorta, and iliac arteries, could further enhance the clarity and intuitiveness of the methodological presentation.  \nIn conclusion, we appreciate the reviewer’s constructive comments, which provide valuable directions for further refining related research. Addressing these issues will help advance the clinical translation of PVAT imaging biomarkers.  \nAcknowledgements  \nThe authors acknowledge the original authors for their significant contribution to this research. Hong-Yu Long and Guo-Dong Chen: investigation, writing – original draft; Bai-Qing Chen: resources, writing – review and editing. All authors have read and approved the final manuscript.  \nAuthor contributions  \nCRediT: Hong-Yu Long: Writing – original draft; Guo-Dong Chen: Writing – original draft; Bai-Qing Chen: Writing – review & editing.  \nDisclosure statement  \nNo potential conflict of interest was reported by the authors.  \nFunding  \nThe author(s) reported there is no funding associated with the work featured in this article.  \nORCID  \nBai-Qing Chen  [http://orcid.org/0000-0001-5089-7512](http://orcid.org/0000-0001-5089-7512)  \n2  H.-Y. LONG ET AL.  \nData availability statement  \nData sharing is not applicable to this article as no data were created or analysed in this study.  \nReferences  \n[1] Liu Y, Chen L, Liu J. Letter to the Editor regarding “Local large arterial perivascular adipose tissue metabolic and anatomical features are associated with hypertensive clinical outcomes: a PET/CT-based study” by Long HYet al. Ann Med. 2025;57(1):2599604 . doi:10 . 1080/07853890 .2025.2599604.  \n[2] Long HY, Chen GD, Liu JL, et al. Local large arterial perivascular adipose tissue metabolic and anatomical features are associated with hypertensive clinical outcomes: a PET/CT-based study. Ann Med. 2025;57(","cbCaiieDfWiOxsSE","https://ap.wps.com/l/cbCaiieDfWiOxsSE","pdf",190328,"English","# Letter to the Editor\n## Response points\n### VFA quantification\n### LASSO regression\n### Visualization and segmentation\n## Conclusion\n## Disclosures and funding\n## Author information","[{\"question\":\"What is the main purpose of this letter to the editor?\",\"answer\":\"To respond to authors’ comments on a PET/CT-based study examining vertebra-level PVAT assessment and its association with hypertensive clinical outcomes.\"},{\"question\":\"How do the authors address the suggestion about quantifying visceral fat area (VFA)?\",\"answer\":\"They agree that adding VFA measurements on CT images, such as at the L3 level, could improve analysis by better accounting for PVAT plasticity influenced by central obesity, diet, or physical activity.\"},{\"question\":\"What future methodological improvements do the authors propose?\",\"answer\":\"They plan more extensive LASSO analyses to verify feature selection reliability and suggest adding multiplanar reconstruction or maximum intensity projection images with color-coded major artery annotations to enhance methodological clarity and reproducibility.\"}]","Response to letter regarding ‘local large arterial perivascular adipose tissue metabolic and anatomical features are associated with hypertensive clinical outcomes: a PET/CT-Based study’ | PDF",1790729955]