Cardiac CT for coronary artery atherosclerosis detection: Potential applications in symptomatic and asymptomatic individuals
Thomas M. Todoran, MD, MS
Despite current methods of identifying patients with coronary artery atherosclerosis, many individuals suffer cardiovascular events in the absence of established risk factors. Thus, current diagnostic paradigms for the detection of coronary artery atherosclerosis are inadequate. Consequently, there is an impetus to develop improved noninvasive imaging modalities to better detect coronary artery disease (CAD) and determine the prognosis of future cardiovascular events. Cardiac computed tomography (CT) has the capacity to directly visualize the coronary arteries. Cardiac CT can be performed to detect coronary artery stenoses and assess nonobstructive stages of coronary atherosclerosis either through calcium measurement or the analysis of calcified and noncalcified plaque. There are some clinical recommendations for the use of coronary CT angiography (CTA) for symptomatic patients, as well as for the use of coronary artery calcium (CAC) measurement in patients who are asymptomatic but are at intermediate risk for CAD events based on the Framingham risk assessment. There are currently no clinical indications for coronary CTA in asymptomatic individuals for stenosis detection or assessment of coronary artery plaque.