Screening coronary CT angiography: possibilities and pitfalls

Excerpt

Coronary artery calcium scoring (CACS) is a standard imaging tool to predict future cardiac events in asymptomatic subjects with intermediate Framingham risk score (FRS) due to its high accuracy for detecting coronary artery disease (CAD) [1]. In fact, the recently published 2013 guidelines of the AHA/ACC suggest an additional role for CACS in certain asymptomatic patients who are being considered for statin therapy but who are not included in four major statin benefit groups [2]. Notwithstanding these statements, it is undeniable that coronary CTA provides clearer anatomic definition of CAD than CACS and thus may have a role in screening for individuals at risk for CAD. The greatest advantage of coronary CTA over CACS is in visualization of the extent and type of coronary plaque. It has been estimated that CACS identifies only 20 % of total plaque volume that is present histologically [3]. Not only does coronary CTA visualize more of the total plaque amount, but it can provide superior information as to its location, whether the plaque is calcified, non-calcified or mixed, obstructive or non-obstructive and the status of vessel remodeling. …