Coronary Computed Tomography Angiography

Coronary computed tomographic angiography (cCTA) as a noninvasive approach underlies a rapid technological development with an impressive improvement of spatial and temporal resolution of the images. Therefore, it has become an accurate and cost-effective method to detect or exclude obstructive coronary artery disease (CAD) in patients with low to medium cardiovascular risk profile, as recommended by the ESC/AHA/ACC guidelines. The results show an excellent sensitivity, but still with a lack of specificity compared with invasive measurement. Several novel techniques like myocardial perfusion, plaque characterization or CT-based measurement of the fractional flow reserve have been developed to improve the positive predictive value and create more accurate results in detecting hemodynamically relevant stenoses. Moreover, during the last decade, the need to reduce radiation dose has become a central issue in clinical use, while the current generation of CT scanners has drastically lowered radiation dose. In conclusion, cCTA has become a promising alternative to invasive cardiac catheterization with still existing limitations. Thus, an appropriate patient selection is mandatory to utilize the advantages of this technique.