Overview
Cardiac computed tomography provides high-resolution anatomic assessment of the coronary arteries, cardiac structures, great vessels, and surrounding thorax. Its principal strengths are coronary artery evaluation, calcium quantification, and procedural planning.
Core Strengths¶
Cardiac CT is particularly useful for evaluating:
- Coronary artery anatomy and stenosis
- Coronary artery calcium
- Atherosclerotic plaque
- Anomalous coronary arteries
- Coronary bypass grafts
- Selected coronary stents
- Left atrial appendage anatomy and thrombus
- Pulmonary vein anatomy
- Structural heart interventions
- Aortic disease
- Congenital heart disease
- Cardiac masses
- Pericardial anatomy
How Cardiac CT Answers Clinical Questions¶
| Clinical question | Principal CT technique |
|---|---|
| Is coronary atherosclerosis present? | Coronary calcium scoring |
| Is obstructive CAD present? | Coronary CT angiography |
| Is an intermediate stenosis flow-limiting? | CT-derived fractional flow reserve |
| What are the plaque characteristics? | CCTA plaque assessment |
| Is a coronary anomaly present? | CCTA with 3D reconstruction |
| Is left atrial appendage thrombus present? | Early and delayed-phase CT |
| What is the pulmonary vein anatomy? | ECG-gated left atrial CT |
| Is the patient anatomically suitable for TAVR? | TAVR planning CT |
| What is the extent of aortic disease? | ECG-gated or nongated CT angiography |
| Is the pericardium thickened or calcified? | Cardiac or chest CT |
Major Limitations¶
- Ionizing radiation
- Iodinated contrast exposure
- Image degradation from motion or arrhythmia
- Reduced coronary interpretability with extensive calcification
- Limited functional and tissue characterization compared with CMR
- Heart-rate control may be required
- Breath-holding is necessary for optimal image quality
- Obesity can reduce image quality and increase radiation exposure
- CT stenosis severity does not always establish physiologic significance
Planned Topics¶
- Cardiac CT Fundamentals
- Acquisition and Protocols
- Coronary Anatomy
- Coronary CT Angiography
- Coronary Calcium Scoring
- Plaque Characterization
- CT-Derived Fractional Flow Reserve
- Structural Heart CT
- TAVR Planning
- Pulmonary Vein CT
- Left Atrial Appendage Imaging
- Congenital Heart Disease
- Aortic CT
- Cardiac Masses
- Pericardial Disease
- Artifacts and Pitfalls
- Radiation and Contrast Safety
- Reporting Guide
Note
This section is under development.