Non-alcoholic fatty liver disease is a strong predictor of carotid high-risk plaques as assessed by high-resolution magnetic resonance imaging

Tianqi Xu; Boning Guo; Sha Li; Shuai Zhang; Ximing Wang

doi:10.21037/qims-24-1326

Non-alcoholic fatty liver disease is a strong predictor of carotid high-risk plaques as assessed by high-resolution magnetic resonance imaging

Quant Imaging Med Surg. 2025 Jan 2;15(1):898-910. doi: 10.21037/qims-24-1326. Epub 2024 Dec 30.

Authors

Tianqi Xu^{1

2}, Boning Guo^{1

3}, Sha Li^{1

2}, Shuai Zhang^#², Ximing Wang^#²

Affiliations

¹ Cheeloo College of Medicine, Shandong University, Jinan, China.
² Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, China.
³ Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.

^# Contributed equally.

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease with a high prevalence. Recent data suggest that NAFLD may be an independent risk factor for cardiovascular disease (CVD). This study aimed to investigate the association between NAFLD and carotid high-risk plaque (HRP) as assessed by high-resolution magnetic resonance imaging (MRI), and to examine the diagnostic value of NAFLD.

Methods: A total of 125 patients with carotid plaques who underwent high-resolution MRI and unenhanced abdominal computed tomography (CT) examinations were included in this retrospective study. NAFLD was defined as a liver/spleen Hounsfield unit (HU) ratio <1.0 on a non-contrast CT scan. The criteria for defining HRP were at least one of the following features: fibrous cap rupture (FCR); a large lipid-rich necrotic core (LRNC) (occupying >40% of the wall area); or intraplaque hemorrhage (IPH). Univariable and multivariable logistic regression analyses were conducted to examined the association between HRP and NAFLD. The adjusted receiver operating characteristic (aROC) curve and the adjusted area under the curve (aAUC) with the 95% confidence interval (CI) were calculated for each model.

Results: Compared with the patients without NAFLD, those with NAFLD had a higher prevalence of IPH, large LRNC, and FCR (all P<0.001). HRP was more commonly observed in the plaques of the NAFLD patients than the non-NAFLD patients (P<0.001). The multivariate analyses showed that NAFLD was an independent predictor of carotid HRP [odds ratio (OR) =12.06, 95% CI: 3.66-39.76, P<0.001]. The aROC curve analysis showed that NAFLD had an outstanding diagnostic ability (aAUC =0.95) in identifying HRP after adjusting for risk factors.

Conclusions: NAFLD is associated with carotid HRP as assessed by high-resolution MRI. CT-defined NAFLD may be a novel and robust predictor for identifying HRP.

Keywords: Non-alcoholic fatty liver disease (NAFLD); carotid plaques; high-resolution magnetic resonance imaging; unenhanced abdominal computed tomography (unenhanced abdominal CT).