Coronary computed tomography angiography: modern capabilities of the technique and place in everyday clinical practice

Coronary artery disease (CAD) remains the leading cause of death worldwide. While invasive coronary angiography is the gold standard for lumen visualization, it falls short in morphological assessment of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) offers a non-invasive alternative, enabling detailed analysis of coronary artery anatomy and structural plaque characteristics crucial for determining instability and rupture risk. Modern computed tomography (CT) technologies, including dynamic CT perfusion and CT-fractional flow reserve (FFRCT), further enhance CCTA by providing functional assessment of coronary atherosclerosis. Current clinical guidelines position CCTA as a primary non-invasive method for CAD verification, particularly for patients with suspected stable CAD and intermediate pre-test probability. This comprehensive review elucidates the contemporary diagnostic capabilities of CCTA, including its role in assessing anatomical severity and plaque morphology. It details the standardized CAD-RADS reporting system, discusses the utility of FFRCT and CT perfusion for functional stenosis evaluation, and addresses technical limitations and their mitigation. The article emphasizes CCTA’s growing importance in personalized medicine and optimizing patient management pathways.