Pitfalls in Coronary CTA Interpretation

This chapter discusses the causes of stenosis misinterpretation and how to avoid it. False positive results of CCTA, which are overestimating the severity of coronary stenosis compared to the standard of invasive angiography, are more common than a false negative diagnosis (missing the presence of plaque or a significant stenosis) but the latter has a more serious impact on patient outcomes and management. This chapter outlines how to recognize plaque in challenging locations, such as at ostia, bifurcations, or are affected by degraded image quality. Heavily calcified plaques represent a particular challenge, and are generally associated with false positive results, though less commonly also with underappreciation of stenosis severity. Methods of approaching calcified plaques are being provided.