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目的:探讨自由呼吸CT评价心外膜脂肪组织(EAT)容积和形态的准确性，并基于其探索n 18F-FDG PET/CT “一站式”评价心房颤动(简称房颤)患者EAT容积和活性的特征。n 方法:(1)选取北京朝阳医院2020年3月至2020年5月间20例行常规n 18F-FDG PET/CT显像、无明显影响心脏及其周围肺部图像疾病患者[男16例、女4例，年龄33~86(61.1±14.2)岁]的自由呼吸CT和吸气末屏气高分辨率CT(HRCT)图像进行回顾性研究，通过Spearman秩相关分析、Bland-Altman一致性分析和组内相关系数(ICC)评价两者测定EAT容积和形态的相关性和一致性，以及2名操作者测量的重复性；(2)前瞻性研究纳入2017年8月至2018年8月间北京朝阳医院采集的20例房颤患者[男6例、女14例，年龄52~76(66.0±6.4)岁]和10名健康对照[男3名、女7名，年龄59~69(66.0±3.6)岁]的n 18F-FDG PET/CT图像，通过Mann-Whitney n U检验比较房颤患者和健康对照组EAT容积和n 18F-FDG SUVn max的差异。EAT容积测量通过Mimics Research 21.0软件自动+手动辅助完成，EAT形态通过软件自动计算出的三维模型在基准坐标轴(n x、n y、n z)上投影的最大长度表示；手动测量EAT的SUVn max。n 结果:同一操作者2次测量EAT容积的结果(ICC＝0.999)及2名操作者分别测量的结果(ICC＝0.997)均具有良好的重复性。自由呼吸CT与吸气末屏气HRCT测得的EAT容积具有良好的相关性[96.6(79.9，136.4)和96.2(80.9，135.8) ml; n rs＝0.929，n P<0.001]和一致性[19例患者数据在95%一致性界限(95% LoA)内]；两者EAT三维模型在基准坐标轴上的投影长度最大值具有良好的相关性和一致性(n x轴：n rs＝0.869，n P<0.001，19例患者数据在95% LoA内；n y轴n rs＝0.854，n P<0.001，18例患者数据在95% LoA内；n z轴n rs＝0.586，n P＝0.007，20例患者数据全部在95% LoA内)。房颤组EAT容积高于健康对照组[137.2(113.9，202.9)与94.4(76.6，134.4) ml; n z＝-2.11，n P＝0.035]；房颤组EAT的SUVn max亦高于健康对照组[1.2(1.1，1.5)与1.1(1.0，1.2); n z＝-2.14，n P＝0.035]。n 结论:自由呼吸CT与吸气末屏气HRCT对EAT容积和形态的测量具有良好的相关性、一致性和测量重复性。利用n 18F-FDG PET/CT可以“一站式”评价EAT容积和活性的异常。n “,”Objective:To investigate the accuracy of free-breathing CT in evaluating the volume and shape of epicardial adipose tissue (EAT), and further explore the characteristics of EAT volume and activity in patients with atrial fibrillation using n 18F-FDG PET/CT “ one-stop” imaging.n Methods:(1) Retrospective analysis was performed on 20 patients (16 males, 4 females, age: 33-86 (61.1±14.2) years) who underwent n 18F-FDG PET/CT imaging and without obvious diseases affecting the images of the heart and surrounding lungs between March 2020 and May 2020 in Beijing Chaoyang Hospital. Free-breathing CT and breath-hold high resolution CT (HRCT) images were reviewed. Spearman rank correlation analysis, Bland-Altman consistency analysis and intraclass correlation coefficient (ICC) were used to evaluate the correlation and consistency of the EAT volume and shape, as well as the repeatability of the two operators′ measurements. (2) Prospective analysis was conducted to compare the differences in EAT volume and n 18F-FDG uptake values between 20 patients (6 males, 14 females, age: 52-76 (66.0±6.4) years) with atrial fibrillation and 10 healthy controls (3 males, 7 females, age: 59-69 (66.0±3.6) years) collected between August 2017 and August 2018 in Beijing Chaoyang Hospital. Mann-Whitney n U test was used to compare the differences in EAT volume and n 18F-FDG SUVn max between patients with atrial fibrillation and healthy controls. EAT volume measurement was conducted by the combination of Mimics Research 21.0 software and manual analysis. The shape of EAT was automatically calculated by the same software to obtain the maximum length of the projection of the three-dimensional (3D) model on the reference axes (n x, y, z). SUVn max of EAT was manually measured.n Results:The measurements of EAT volume had good repeatability (intra-operator ICC=0.999; inter-operator ICC=0.997). There was a good correlation and a good consistency between EAT volumes measured by free-breathing CT and breath-hold HRCT (96.6 (79.9, 136.4) n vs 96.2 (80.9, 135.8) ml; n rs=0.929, n P<0.001); data of 19 cases were within 95% limits of agreement (95% LoA). The maximum projection length of EAT 3D model on the reference coordinate axis also showed good correlation and consistency (n x axis: n rs=0.869, n P<0.001, data of 19 cases were within 95% LoA;n y axis: n rs=0.854, n P<0.001, data of 18 cases were within 95% LoA;n z axis: n rs=0.586, n P=0.007, data of 20 cases were within 95% LoA). EAT volume of atrial fibrillation group was higher than those of healthy control group (137.2 (113.9, 202.9) n vs 94.4 (76.6, 134.4) ml; n z=-2.11, n P=0.035) and SUVn max of EAT in the atrial fibrillation group was higher than that in healthy control group (1.2 (1.1, 1.5) n vs 1.1 (1.0, 1.2); n z=-2.14, n P=0.035).n Conclusions:Free-breathing CT and breath-hold HRCT have good correlation, consistency and repeatability in measurement of EAT volume and shape. n 18F-FDG PET/CT can be a “ one-stop” imaging strategy for the evaluation of EAT volume and activity.n