Dinshaw, Homeyar; Delaney, Patrick; Reilly, John P.
Cardiac computed tomography angiography (CCTA) produces excellent anatomic information of the coronary arteries and other cardiac structures. A high negative predictive value (99%) for the exclusion of coronary lesions establishes CCTA as a highly effective noninvasive alternative to invasive coronary angiography. It is, however, less accurate for determining degrees of lesion severity, and intermediate grade lesions require either physiologic stress testing or invasive coronary angiography. CCTA allows visualization of the vessel wall so plaque can be classified as soft, calcified, or mixed on the basis of Hounsfield units. Precise quantification of the plaque burden is readily performed with coronary artery calcium scoring CACS). This measurement of plaque burden is one of the most predictive of future cardiac events and mortality available. CCTA also serves as an excellent tool prior to surgical and percutaneous cardiac procedures. CT scanning continues to evolve as an imaging modality for all stages of the treatment of cardiac disease: CACS for risk assessment for asymptomatic patients, CCTA to evaluate patients with symptoms, and cardiac CT to plan cardiac procedures.