Breast adipose tissue attenuation as a novel imaging biomarker for cardiometabolic risk

Background Certain adipose tissue depots infer higher cardiometabolic risk than body mass index (BMI). Purpose To assess breast adipose tissue (BrAT) attenuation as a novel imaging biomarker for cardiometabolic risk. Material and Methods We studied 151 women (mean age = 56 +/- 1 years) across the weight spectrum. BrAT attenuation, abdominal adipose tissue cross-sectional areas (CSA), and attenuation were quantified using non-contrast computed tomography (CT) scans. Cardiometabolic risk factors were assessed from medical records. Results BrAT attenuation was lower in obese women compared to lean women. BrAT attenuation was inversely associated with BMI, waist circumference, abdominal fat CSA, fasting glucose, and triglycerides (P <= 0.02), and positively associated with abdominal adipose tissue attenuation (P < 0.001). BrAT attenuation had a sensitivity of 90% but a specificity of only 35% in detecting the metabolic syndrome (area under the curve = 0.63). Conclusion BrAT attenuation is associated with cardiometabolic risk markers and could serve as an imaging biomarker for opportunistic risk assessment in patients undergoing CT examination of the chest.