Chang, Yoosoo, Yoon, Soon Ho, Kwon, Ria, Kang, Jeonggyu, Kim, Young Hwan, Kim, Jong-Min, Chung, Han-Jae, Choi, JunHyeok, Jung, Hyun-Suk, Lim, Ga-Young, Ahn, Jiin, Wild, Sarah H., Byrne, Chris and Ryu, Seungho (2024) Automated comprehensive CT assessment of the risk of diabetes and associated cardiometabolic conditions. Radiology, 312 (2), e233410, [e233410]. (doi:10.1148/radiol.233410).
Abstract
Background: CT, performed for various clinical indications has the potential to predict cardiometabolic diseases. However, the predictive ability of individual CT parameters remains underexplored.
Purpose: to evaluate the ability of automated CT-derived markers to predict diabetes and associated cardiometabolic comorbidities.
Materials and Methods: this retrospective study included Korean adults (age ≥25 years) who underwent health screening with 18F-fluorodeoxyglucose (18F-FDG) PET/CT between January 2012 and December 2015. Fully automated CT markers included visceral/subcutaneous fat, muscle, bone density, liver fat, all normalized to height (m2) and aortic calcification. Predictive performance was assessed using area under the receiver operating characteristic curve (AUC) and Harrell C-index in the cross-sectional and survival analyses, respectively.
Results: the cross-sectional and cohort analyses included 32166 (mean age, 44.6 years ±5.7 [SD], 28833 men) and 27298 adults (mean age, 43.8 years ±4.8 [SD], 24820 men), respectively. Diabetes prevalence and incidence were 6% at baseline and 9% during the 7.3-year median follow-up, respectively. The visceral fat index showed the highest predictive performance for prevalent and incident diabetes, yielding AUCs of 0.70 (95%CI: 0.68, 0.71) in men and 0.82 (95%CI: 0.78, 0.85) in women, and Harrell C-indices of 0.68 (95%CI: 0.67, 0.69) in men and 0.82 (95%CI: 0.77, 0.86) in women, respectively. Combining the visceral fat, muscle area indices, liver fat fraction, and aortic calcification improved the predictive performance, yielding Harrell C-indices of 0.69 (95%CI: 0.68, 0.71) in men and 0.83 (95%CI: 0.78, 0.87) in women. Visceral fat index AUCs for identifying metabolic syndrome were 0.81 (95%CI: 3 0.80, 0.81) in men and 0.90 (95%CI: 0.88, 0.91) in women. Automated CT-derived markers also identified US-diagnosed fatty liver, coronary artery calcium scores >100, sarcopenia, and osteoporosis, with AUCs ranging from 0.80 to 0.95.
Conclusion: automated comprehensive multiorgan CT analysis identified individuals at current and future high risk of diabetes and other cardiometabolic comorbidities
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