The evolving role of cardiac CT: Emerging technologies and clinical impact.
Authors
Affiliations (16)
Affiliations (16)
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan. Electronic address: [email protected].
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
- Department of Radiology, The University of Osaka Graduate School of Medicine, Osaka, 565-0871, Japan.
- Department of Radiology, Institute of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan.
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, 807-8555, Japan.
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8520, Japan.
- Department of Innovative BioMedical Visualization, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan.
- Preemptive Medicine and Lifestyle-related Disease Research Center, Kyoto University Hospital, Kyoto, 606-8507, Japan.
- Radiation Oncology Division, Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan.
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan.
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan.
- Department of Artificial Intelligence, Graduate School of Medicine, Osaka Metropolitan University, Osaka, 545-8585, Japan.
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, 104-0045, Japan.
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
- Department of Diagnostic Imaging, Faculty of Medicine, Hokkaido University, Sapporo, 060-8638, Japan.
Abstract
Cardiac computed tomography (CT) has progressed from a non-invasive test primarily used to exclude obstructive coronary artery disease into a comprehensive cardiovascular imaging platform for coronary artery disease, myocardial disease, valvular heart disease, and structural heart disease. Coronary CT angiography (CCTA) is now endorsed as a first-line test in appropriately selected patients with stable chest pain or suspected chronic coronary syndromes because it can exclude obstructive disease, depict coronary atherosclerotic burden, support preventive treatment, and inform referral for invasive coronary angiography. At the same time, contemporary cardiac CT is moving beyond luminal stenosis. CT-derived fractional flow reserve and myocardial CT perfusion add a functional assessment of ischemia, whereas late iodine enhancement, CT-derived extracellular volume fraction, myocardial strain, and pericoronary fat attenuation index provide information on fibrosis, ventricular mechanics, vascular inflammation, and prognosis. Cardiac CT also has an established role in transcatheter valve therapy, left atrial appendage occlusion, and prosthetic valve assessment by providing a three-dimensional roadmap for device selection, access planning, and complication prediction. Photon-counting detector CT and artificial intelligence are further expanding the capabilities of cardiac CT through higher spatial resolution, spectral quantification, automated segmentation, quantitative plaque analysis, image reconstruction, and structured reporting. This review summarizes the evidence, technical foundations, clinical applications, and implementation challenges of contemporary cardiac CT, with an emphasis on its transition toward a decision-making platform for personalized cardiovascular care.