Feasibility of Predicting the Triglyceride/High-Density Lipoprotein Cholesterol Ratio using Spectral Imaging with a...

Non-alcoholic fatty liver disease (NAFLD) is closely associated with increased cardiovascular risk, and the triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio is a reliable predictor of cardiometabolic disorders. Dual-energy CT with Multi-Material Decomposition (MMD) enables non-invasive quantification of liver Fat Fraction (FF), but its value in predicting TG/HDL-C ratio remains unexplored. To investigate the correlation between the triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio, and spectral parameters, liver Fat Fraction (FF) measured by Multi-Material Decomposition (MMD), and to validate their predictive value.

A total of 96 subjects (50 Non-Alcoholic Fatty Liver Disease (NAFLD) patients, 46 healthy individuals) were divided into low-ratio (TG/HDL-C ≤1.5, n=56) and high-ratio (TG/HDL-C >1.5, n=40) groups. Abdominal fast kVp-switching dual-energy CT was performed to measure FF (left lobe (FFL), right anterior lobe (FFRA), right posterior lobe (FFRP)), visceral fat content (FV), virtual monochromatic CT values (HU50-100keV), and liver/spleen CT value ratio (HUL/S). Correlation and ROC analyses were conducted.

TG/HDL-C ratio was positively correlated with FFL, FFRA, FFRP, FV (r=0.7514–0.3787, p<0.001) and negatively correlated with HU50-100keV and HUL/S (r=-0.4171–-0.7513, p<0.001). The high-ratio group had higher FF and FV, lower HU50-100keV and HUL/S (p<0.05). ROC analysis showed the highest AUC was 0.884 (FFRP), followed by FFRA (0.880), FFL (0.872), HUL/S (0.837), and HU100keV (0.835).

MMD-derived FF (especially FFRP) exhibited superior predictive performance for TG/HDL-C ratio compared to spectral CT parameters and visceral fat content. This advantage stems from FF’s direct quantification of intrahepatic fat (pathological basis of NAFLD-metabolic interplay), while HU-based parameters are confounded by non-fat tissue components. The study establishes a novel imaging-metabolic association, extending dual-energy CT’s utility from NAFLD diagnosis to cardiovascular risk stratification.

MMD-measured FF and dual-energy CT spectral parameters are correlated with TG/HDL-C ratio, and FF exhibits the best predictive performance for TG/HDL-C in NAFLD patients.