Cardiac CT: understanding and adopting a new diagnostic modality

For many years, the holy grail in cardiac imaging was the noninvasive anatomic evaluation of the coronary arteries. Although functional tests allow for the detection of ischemia, they lack sufficient sensitivity and specificity to reliably exclude obstructive coronary artery disease in many symptomatic patients, and have practically no role in establishing the presence of non-obstructive disease in asymptomatic subjects who may benefit from preventive interventions. The very short history of cardiac CT has demonstrated rapid technological advances and the potential to eliminate the need for invasive diagnostic testing in patients who have suspected coronary artery disease. This article reviews the history of this modality, the principles and challenges for its clinical implementation, and provides a preamble to this special issue of Cardiology Clinics.