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The identification and treatment of patients at risk of cardiovascular events thus are as important as ever. Adipose tissue is a classic risk factor for cardiovascular diseases, has been linked to systemic inflammation, and is suspected to contribute to vascular calcification. To further investigate this issue, the use of texture analysis of adipose tissue using radiomics features could prove a feasible option.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this retrospective single-center study, 55 patients (mean age 56, 34 male, 21 female) were scanned on a first-generation photon-counting CT. On axial unenhanced images, periaortic adipose tissue surrounding the thoracic descending aorta was segmented manually. For feature extraction, patients were divided into three groups, depending on coronary artery calcification (Agatston Score 0, Agatston Score 1\u201399, Agatston Score\u2009\u2265\u2009100). 106 features were extracted using pyradiomics. R statistics was used for statistical analysis, calculating mean and standard deviation with Pearson correlation coefficient for feature correlation. Random Forest classification was carried out for feature selection and Boxplots and heatmaps were used for visualization. Additionally, monovariable logistic regression predicting an Agatston Score\u2009&gt;\u20090 was performed, selected features were tested for multicollinearity and a 10-fold cross-validation investigated the stability of the leading feature.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Two higher-order radiomics features, namely \u201cglcm_ClusterProminence\u201d and \u201cglcm_ClusterTendency\u201d were found to differ between patients without coronary artery calcification and those with coronary artery calcification (Agatston Score\u2009\u2265\u2009100) through Random Forest classification. As the leading differentiating feature \u201cglcm_ClusterProminence\u201d was identified.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Changes in periaortic adipose tissue texture seem to correlate with coronary artery calcium score, supporting a possible influence of inflammatory or fibrotic activity in perivascular adipose tissue. Radiomics features may potentially aid as corresponding biomarkers in the future.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12880-023-01058-7","type":"journal-article","created":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T17:52:42Z","timestamp":1690393962000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Periaortic adipose radiomics texture features associated with increased coronary calcium score\u2014first results on a photon-counting-CT"],"prefix":"10.1186","volume":"23","author":[{"given":"Peter","family":"Mundt","sequence":"first","affiliation":[]},{"given":"Hishan","family":"Tharmaseelan","sequence":"additional","affiliation":[]},{"given":"Alexander","family":"Hertel","sequence":"additional","affiliation":[]},{"given":"Lukas T.","family":"Rotkopf","sequence":"additional","affiliation":[]},{"given":"Dominik","family":"N\u00f6renberg","sequence":"additional","affiliation":[]},{"given":"Philipp","family":"Riffel","sequence":"additional","affiliation":[]},{"given":"Stefan O.","family":"Schoenberg","sequence":"additional","affiliation":[]},{"given":"Matthias F.","family":"Froelich","sequence":"additional","affiliation":[]},{"given":"Isabelle","family":"Ayx","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,7,26]]},"reference":[{"key":"1058_CR1","unstructured":"The top 10 causes of death, WHO. 2020, https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death Accessed 19 Aug 2022."},{"issue":"2","key":"1058_CR2","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.jcmg.2014.11.008","volume":"8","author":"SM Chang","year":"2015","unstructured":"Chang SM, Nabi F, Xu J, Pratt CM, Mahmarian AC, Frias ME, et al. 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