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Computed Tomography Evaluation of Coronary Atherosclerosis: The Road Travelled, and What Lies Ahead
Chadi Ayoub1, Isabel G Scalia1, Nandan S Anavekar2
1Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA.
Insights
Coronary CT angiography (CCTA) is a key tool for diagnosing coronary artery disease (CAD), offering rapid rule-out and detailed plaque analysis. Advances include functional assessment and AI, shaping future cardiac imaging.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Technology
Background:
- Coronary artery disease (CAD) is a major cause of death.
- Coronary CT angiography (CCTA) is recommended for chest pain evaluation.
- CCTA aids in diagnosing and assessing CAD risk.
Purpose of the Study:
- Review the evolution of CCTA in CAD assessment.
- Detail quantitative plaque analysis and functional assessments.
- Discuss current guidelines, applications, and future directions in CCTA.
Main Methods:
- Comprehensive literature review of CCTA advancements.
- Analysis of diagnostic and prognostic value of CCTA.
- Examination of quantitative plaque assessment, FFR-CT, and CT perfusion.
Main Results:
- CCTA enables rapid, cost-effective CAD rule-out.
- It quantifies plaque burden, extent, and characteristics.
- Functional assessments like FFR-CT and CT perfusion are integrated.
Conclusions:
- CCTA is a cornerstone in CAD investigation and risk stratification.
- Technological advancements like AI and photon counting will further enhance CCTA.
- Future CCTA applications promise improved patient outcomes in cardiology.
Abstract:
Coronary CT angiography (CCTA) is now endorsed by all major cardiology guidelines for the investigation of chest pain and assessment for coronary artery disease (CAD) in appropriately selected patients. CAD is a leading cause of morbidity and mortality. There is extensive literature to support CCTA diagnostic and prognostic value both for stable and acute symptoms. It enables rapid and cost-effective rule-out of CAD, and permits quantification and characterization of coronary plaque and associated significance. In this comprehensive review, we detail the road traveled as CCTA evolved to include quantitative assessment of plaque stenosis and extent, characterization of plaque characteristics including high-risk features, functional assessment including fractional flow reserve-CT (FFR-CT), and CT perfusion techniques. The state of current guideline recommendations and clinical applications are reviewed, as well as future directions in the rapidly advancing field of CT technology, including photon counting and applications of artificial intelligence (AI).
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