CT-Derived Adipose Tissue Biomarkers in Coronary and Carotid Atherosclerosis: A Systematic Review of Dual-Energy, Spectral, and Photon-Counting CT

Background/Objectives: Advanced Computed Tomography (CT) enables multiparametric characterization of local perivascular and regional or systemic adipose tissue, potentially providing markers of vascular inflammation and cardiometabolic remodeling beyond conventional assessment of the vessel lumen and plaque. However, evidence remains fragmented across CT technologies, adipose depots and vascular territories. This systematic review evaluated human studies of adipose-tissue biomarkers derived from dual-layer spectral-detector CT (DLSCT), dual-source dual-energy CT (DS-DECT), rapid kVp-switching dual-energy CT (rsDECT), and photon-counting CT (PCCT) in coronary and carotid atherosclerosis.

Methods

PubMed and Scopus were systematically searched for English-language human studies published from 1 January 2020, to 13 September 2026, supplemented by backward and forward citation searching of eligible studies and reference-list screening of relevant reviews. Two reviewers independently performed study selection and risk-of-bias assessment. Because of clinical, technical, and methodological heterogeneity, findings were synthesized narratively without meta-analysis.