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Cardiac CT: current practice and emerging applications
  1. Subhi J Al’Aref1,
  2. James K Min2
  1. 1 Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and New York Presbyterian Hospital, New York City, New York, USA
  2. 2 Radiology, Weill Cornell Medicine, New York City, New York, USA
  1. Correspondence to Dr James K Min, Radiology, Weill Cornell Medical College, New York City, NY 10065, USA; runone123{at}gmail.com

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Learning objectives

  • To understand the evolution of coronary CT angiography as a non-invasive imaging modality for the diagnosis of coronary artery disease.

  • To develop an appreciation for the role of coronary CT angiography in daily clinical care and the incremental prognostic value of associated findings.

  • To recognise current practices and emerging applications of cardiac CT within healthcare and translational research.

Introduction

Cardiac CT (CCT), as a diagnostic imaging modality, has been instrumental in advancing contemporary understanding of the pathophysiology and evolution of atherosclerotic cardiovascular disease. Initially developed as a non-invasive approach for the detection and quantification of coronary artery calcification, CCT has evolved into a comprehensive imaging modality that provides anatomic and functional information to guide clinical care.1 2 Coronary CT angiography (CCTA) provides the ability to non-invasively visualise atherosclerotic plaque in a manner that provides complimentary information to the traditional measures of diameter stenosis (as typically assessed on invasive coronary angiography) and perfusion defects (as judged on single photon emission CT).3 Further, the presence of coronary artery disease (CAD) has been shown to provide incremental prognostic information, even if non-obstructive, over the short, intermediate and long term follow-up.4–6 In a parallel manner, the non-coronary applications of CCT have been ever-so expanding.7 In this review, we aim to provide an up to date assessment of CCT within the realm of cardiovascular disease to an audience of international trainees and practicing healthcare providers, starting with a state-of-the-art review of current practices for CAD evaluation and ending with a discussion of emerging applications of CCT.

Scanning and acquisition protocols

Throughout the past decade, non-invasive assessment of the coronary arteries using CCTA has emerged as an important addition to clinical care. The development of 64-slice CCT scanners was the milestone that provided the required spatial resolution to reliably visualise the coronary vasculature.8 Since then, rapid …

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