[Computed tomography in cardiology: its necessity and developments]

Cardiac computed tomography angiography (CCTA) has evolved in recent years into a central pillar of non-invasive cardiovascular diagnostics and is now firmly established in both clinical guidelines and everyday practice. In particular, it plays a key role as a first-line modality for ruling out coronary artery disease in patients with low to intermediate pretest probability. In the acute setting, it can also be used in selected patient populations for rapid and reliable exclusion of disease, thereby improving patient management in the emergency department. Beyond the assessment of luminal stenosis, CCTA enables a comprehensive characterization of coronary atherosclerosis. Plaque volume and composition have emerged as key prognostic factors. Modern post-processing techniques allow for increasingly standardized and quantitative analyses, supporting individualized risk stratification and treatment planning. Notably, the detection of subclinical atherosclerosis can facilitate early initiation of preventive strategies and improve patient adherence to therapy. Technological advances such as photon-counting CT, and AI-based plaque analysis have significantly expanded diagnostic capabilities. In addition, CCTA plays an important role in patients after revascularization and in the planning and follow-up of structural heart interventions. Overall, it represents a powerful and versatile imaging modality that substantially enhances diagnosis, risk assessment, and therapeutic decision-making in modern cardiology.