[Coronary CT: from anatomy to physiology].

Area of Science:

• Cardiovascular Imaging
• Artificial Intelligence in Medicine
• Diagnostic Radiology

Context:

• Coronary artery disease (CAD) diagnosis relies on evaluating epicardial stenosis, vulnerable plaques, and microvascular dysfunction.
• Technological advancements, including Artificial Intelligence (AI), are transforming cardiovascular imaging.
• Current diagnostic methods require integration for comprehensive patient assessment.

Purpose:

• To highlight the pivotal role of Coronary Computed Tomography Angiography (CCTA) in diagnosing CAD.
• To demonstrate how technological and AI advancements enable simultaneous anatomical and physiological evaluation.
• To outline the integrated approach for assessing stenosis, vulnerable plaques, and microvascular dysfunction.

Summary:

• Coronary CT angiography (CCTA) is essential for diagnosing coronary artery disease (CAD), assessing epicardial stenosis, vulnerable plaques, and microvascular dysfunction.
• AI and technological progress facilitate integrated anatomical and physiological evaluations, improving stenosis assessment, ischemia evaluation, and therapeutic planning.
• Analysis of vulnerable plaques (atheroma burden, inflammation, wall shear stress) and myocardial perfusion imaging for microvascular dysfunction enhance major adverse cardiac event prediction.

Impact:

• Coronary CT serves as a crucial tool for precision medicine in cardiology.
• It enhances the diagnosis, risk stratification, and tailored management of coronary artery disease.
• Integrated assessments improve patient outcomes through more accurate and personalized treatment strategies.