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Updated: Jul 10, 2025
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Cardiac Computed Tomography in Monitoring Revascularization
Elisabetta Tonet1, Veronica Amantea1, Davide Lapolla1
1Cardiology Unit, Azienda Ospedaliero Universitaria of Ferrara, 44124 Ferrara, Italy.
Insights
Coronary computed tomography angiography (CCTA) is now a valuable tool for assessing stable coronary artery disease, offering both anatomical and functional insights. Advanced technology and new functional assessments make CCTA a comprehensive option, even for patients with prior revascularization.
Area of Science:
- Cardiovascular imaging
- Interventional cardiology
- Radiology
Background:
- Coronary computed tomography angiography (CCTA) is recommended for low-risk stable coronary artery disease.
- High-risk patients traditionally undergo functional tests or invasive angiography due to CCTA artifacts.
- Limitations like blooming and motion artifacts are being overcome by new CCTA technology.
Purpose of the Study:
- To review the evolving role of CCTA in managing coronary artery disease.
- To highlight CCTA's utility in patients with prior revascularization.
- To discuss CCTA's integration of anatomical and functional assessments.
Main Methods:
- Review of recent evidence on CCTA applications.
- Focus on CCTA in stable coronary artery disease, prior revascularization, coronary bypass grafts, and percutaneous coronary intervention.
- Discussion of CT-derived fractional flow reserve and stress CT perfusion.
Main Results:
- New CCTA technology provides high spatial resolution, overcoming previous limitations.
- CT-derived fractional flow reserve and stress CT perfusion enable functional assessment alongside anatomical imaging.
- CCTA facilitates plaque characterization, aiding medical therapy optimization.
- CCTA shows promise in monitoring coronary bypass grafts and percutaneous coronary interventions.
- CCTA offers a noninvasive option for patients with previous revascularization, potentially improving follow-up management.
Conclusions:
- CCTA is becoming a comprehensive examination for coronary artery disease, integrating anatomical and functional data.
- The advancements in CCTA technology and functional assessments position it as a key diagnostic tool, particularly for patients with a history of revascularization.
- CCTA's ability to characterize plaques and monitor interventions offers significant advantages over traditional functional tests.
Abstract:
The use of coronary computed tomography angiography (CCTA) in the setting of stable coronary artery disease is highly recommended for low-risk patients. High-risk patients, such as symptomatic subjects with prior revascularization, are suggested to be investigated with noninvasive functional tests or invasive coronary angiography. CCTA is not considered for these patients because of some well-known CCTA artifacts, such as blooming and motion artifacts. However, new technology has allowed us to obtain images with high spatial resolution, overcoming these well-known limitations of CCTA. Furthermore, the introduction of CT-derived fractional flow reserve and stress CT perfusion has made CCTA a comprehensive examination, including anatomical and functional assessments of coronary plaques. Additionally, CCTA allows for plaque characterization, which has become a cornerstone for the optimization of medical therapy, which is not possible with functional tests. Recent evidence has suggested that CCTA could be used with the aim of monitoring revascularization, both after coronary bypass grafts and percutaneous coronary intervention. With this background information, CCTA can also be considered the exam of choice in subjects with a history of revascularization. The availability of a noninvasive anatomic test for patients with previous coronary revascularization and its possible association with functional assessments in a single exam could play a key role in the follow-up management of these subjects, especially considering the rate of false-positive and negative results of noninvasive functional tests. The present review summarizes the main evidence about CCTA and coronary artery bypass grafts, complex percutaneous coronary intervention, and bioresorbable stent implantation.
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