Updates in cardiovascular CT imaging in 2025: A year in review

The year 2025 brought long-term outcome data supporting coronary CT angiography (CCTA)-guided management of stable chest pain, a proposed reframing of coronary artery disease around atherosclerosis rather than ischemia, and the first large-scale real-world evaluation of a national artificial intelligence (AI)-enabled CT-derived fractional flow reserve (FFR-CT) program. This review summarizes selected advances in cardiovascular computed tomography (CCT) published in print or online during 2025. The studies span coronary artery disease outcomes and prevention, quantitative plaque analysis, photon-counting detector CT, coronary artery calcium scoring, pericoronary inflammation imaging, AI and machine learning, structural and congenital heart disease, and consensus and training documents. For each study we summarize the design, principal findings, limitations, and likely clinical implications, and we close with the barriers, including technical standardization, vendor-specific thresholds, equitable access, and the need for randomized outcome trials, that must be addressed before many of these advances can be implemented broadly.