Computed Tomography Advancements in Plaque Analysis: From Histology to Comprehensive Plaque Burden Assessment

Advancements in coronary computed tomography angiography (CCTA) facilitated the transition from traditional histological approaches to comprehensive plaque burden assessment. Recent updates in the European Society of Cardiology (ESC) guidelines emphasize CCTA's role in managing chronic coronary syndrome by enabling detailed monitoring of atherosclerotic plaque progression. Limitations of conventional CCTA, such as spatial resolution challenges in accurately characterizing plaque components like thin-cap fibroatheromas and necrotic lipid-rich cores, are addressed with photon-counting detector CT (PCD-CT) technology. PCD-CT offers enhanced spatial resolution and spectral imaging, improving the detection and characterization of high-risk plaque features while reducing artifacts. The integration of artificial intelligence (AI) in plaque analysis enhances diagnostic accuracy through automated plaque characterization and radiomics. These technological advancements support a comprehensive approach to plaque assessment, incorporating hemodynamic evaluations, morphological metrics, and AI-driven analysis, thereby enabling personalized patient care and improved prediction of acute clinical events.