Coronary computed tomographic angiography: from anatomical to functional assessment of coronary artery disease

Contrast enhanced computed tomography angiography (CTA) has seen rapid progress in its utility for the assessment of coronary artery disease (CAD) in the last few years. More and more technological enhancements have widened the horizons for the use of this non-invasive modality beyond its traditional role in assessment of coronary anatomy. Present article is an attempt to review the evolution of CTA from the point of view of its clinical utility. The review provides an update on the literature for this transition of CTA from anatomical to physiological assessment of CAD. Multicenter studies showed that coronary computed tomography angiography (CCTA) has a very high diagnostic accuracy and prognostic ability in symptomatic patients; however improvements are still needed for reducing the overestimation of CAD severity and assessment of plaque composition. In asymptomatic populations, there is a lack of studies that show an improved prognostic power of CCTA over other modalities. Additionally, CT has been evaluated for the assessment of the myocardium, myocardial perfusion and viability, cardiac function, wall motion, as well as cardiac valves. Tremendous progress has been made to reduce the radiation dose; however, much effort is still required for making the assessment of myocardial and valvular function an integrative part of the image interpretation for a comprehensive assessment of all aspects of coronary heart disease.