This review examines methodologies employed in deriving physiology from cardiac computed tomography angiography (CCTA), focusing on two primary approaches:1) fractional flow reserve (FFR) calculated from CT images using computational fluid dynamics (CT-FFR); and 2) plaque-derived ischemia/FFR assessment utilizing artificial intelligence and quantitative metrics. Each methodology offers unique advantages in diagnosing and managing coronary artery disease, contributing to CCTA’s evolution into a d…
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Key takeaways from the 2025 expert consensus document on cardiac computed tomography for prosthetic heart valve assessment
The 2025 SCCT/ACC/ESCR/NASCI/RSNA/SCAI/STS expert consensus document provides guidance on the appropriate performance, utilization and interpretation of cardiac CT (CT) for assessing prosthetic heart valves (PHV).1 We highlight our Top 10 recommendations from this practical document which supports the clinical utilization of this imaging modality:
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CCTA and CACS for preoperative cardiovascular risk stratification in patients undergoing noncardiac surgery: A systematic review and meta-analysis
Major Adverse Cardiovascular Events (MACE) is a common cause of perioperative and long-term morbidity and mortality following noncardiac surgery. Patients who require preoperative cardiovascular risk stratification, traditionally undergo noninvasive cardiac imaging using myocardial perfusion imaging or stress echocardiography. Coronary Computed Tomography Angiography (CCTA) and Coronary Artery Calcium Score (CACS) have demonstrated prognostic value in predicting postoperative MACE and effectivel…
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Flow dynamic differences between Kawasaki Disease patients with coronary artery aneurysms and ectasia
Untreated Kawasaki Disease (KD) can lead to coronary artery (CA) dilations, such as CA aneurysms (CAA), CA ectasia (CAE), or both (CAA + CAE). Currently, therapeutic decisions rely solely on geometric measurements, which have limitations. This study aims to correlate differences in flow dynamics between CAA, CAE, and CAA + CAE with clinical outcomes and thrombotic potential.
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Artificial intelligence in Pre-TAVR coronary evaluation: A step forward
Coronary artery disease (CAD) frequently coexists with severe aortic stenosis (AS) and is present in up to 50 % of patients undergoing transcatheter aortic valve replacement (TAVR).1 Given its prognostic implications and the overlap in symptoms between CAD and AS, accurate assessment of CAD is an important component of pre-TAVR evaluation. While invasive coronary angiography (ICA) remains the gold standard, there is growing evidence for coronary computed tomography angiography (CCTA) in evaluat…
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Central and peripheral artery stiffness: Key players in cardiovascular disease risk
The large arteries were once considered inert conduits, delivering oxygenated blood to peripheral tissues. However, large arteries have an important physiological role in buffering the cyclical changes in blood pressure (BP) resulting from intermittent ventricular ejection. With ageing and exposure to cardiovascular disease (CVD) risk factors, the large arteries stiffen, with adverse consequences for the major organs. Indeed, central (elastic) arterial stiffness is now recognized as key, indepen…
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Discrete non-calcified plaque is associated with increased major adverse cardiovascular events in a high cardiovascular risk population with low coronary artery calcium scores (0–100)
Table of Contents Summary: This article identified predictors for discrete non-calcified plaque (NCP) and future adverse cardiovascular events (CVEs) in symptomatic patients from a high cardiovascular risk population with no known coronary artery disease and coronary artery calcium (CAC) scores of 0–100. Risk factors such as hyperlipidemia, diabetes mellitus, tobacco use, older age, elevated systolic blood pressure, and higher total CAC scores were associated with NCP presence. Patients with NCP…
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Pulmonary atresia with bilateral major aortopulmonary collaterals and ventricular septal defect
A 22-year-old male presented to the cardiothoracic surgery department with 1-week of hemoptysis, with worsening for 1-day, accompanied by cough, chest tightness, and dizziness. He reported a history of occasional palpitations after fatigue. Physical examination revealed cyanosis and clubbing fingers (Fig. 1A). The oxygen saturation was 75.2 % and the hematocrit was 0.724L/L. Non-contrast chest CT showed mixed ground-glass opacity in the right upper lobe, suggesting inflammation (Fig. 1B). The e…
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Geographical distribution and accessibility to cardiac CT readers in the United States: A snapshot from the 2022 medicare analysis
Cardiac computed tomography (CCT) is an increasingly important modality for the diagnosis and management of cardiovascular diseases. However, disparities in the availability of trained CCT readers across the United States limit equal access.
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Incremental prognostic value of aortic tortuosity index in older patients undergoing transcatheter aortic valve replacement
In older patients, the complex interplay between muscle deterioration, cognitive decline, and vascular dysfunction represents a crucial triad of health challenges associated with aging.1 Despite its known associations, the incremental prognostic value of vascular impairment in older patients with low muscle mass areas (MMAs) remains unclear. This study aimed to evaluate whether the aortic tortuosity index (ATI) provides incremental prognostic value over muscle mass areas (MMAs) for predicting ad…