Advanced Plaque Evaluation by CT

Assessment of the presence and extent of coronary atherosclerotic disease is central to the evaluation of patients with suspected coronary heart disease. Risk of myocardial infarction or cardiovascular death is strongly related to the total coronary atheroma burden. While coronary calcium scanning allows an estimate of calcified coronary atheroma burden, it cannot account for noncalcified atherosclerosis. Automated arterial contour detection enables rapid assessment of total coronary atheroma burden which is predictive of patient outcome. However, standards for assessment and reporting have not been established and inter-scan reproducibility is modest at this time. Data supporting automated plaque detection over visual estimates for clinical practice are lacking. Similarly, there are no data demonstrating improved patient outcome informed by advanced coronary atherosclerotic plaque characterization vs. conventional methods. The field is rapidly evolving, however, and it is likely that automated coronary atheroma assessment will eventually be the mainstay of coronary artery disease evaluation.