Key result
Multimodality noninvasive imaging integrates anatomy, physiology, and plaque burden to guide personalized CAD management.
Why the study?
The evaluation of CAD has evolved beyond identifying obstructive epicardial stenosis alone to require an integrated assessment of anatomy, plaque, physiology, viability, and microvascular dysfunction, while emerging imaging technologies require varying degrees of validation before routine implementation.
Provides a practical, question-directed clinical framework for selecting complementary anatomic and functional noninvasive imaging modalities in the contemporary evaluation of coronary artery disease.
Answers are grounded in this paper and cite their sources.
Supports complementary anatomic-functional imaging selection in CAD; leaves open prospective validation of photon-counting CT and AI on outcomes.
Coronary artery disease (CAD) remains a leading cause of cardiovascular morbidity and mortality, and its evaluation has evolved beyond the identification of obstructive epicardial stenosis alone. Contemporary imaging increasingly emphasizes an integrated assessment of coronary anatomy, plaque burden and composition, lesion-specific ischemia, myocardial viability, scar, ventricular remodeling, and coronary microvascular dysfunction. Anatomic and functional imaging provide complementary information regarding coronary atherosclerosis, lesion-specific physiology, inducible ischemia, myocardial blood flow, viability, scar, and microvascular disease, with test selection guided by the clinical question and patient characteristics. Randomized trials of specific imaging-guided strategies have demonstrated differences in diagnostic efficiency, downstream invasive angiography, preventive therapy, revascularization, and procedural complications. In contrast, effects on symptoms and hard cardiovascular outcomes vary according to the population, comparator, and duration of follow-up. Emerging technologies, including artificial intelligence, radiomics, photon-counting computed tomography, molecular imaging, and hybrid imaging, are at different stages of clinical readiness and require varying degrees of further validation before routine implementation. This review summarizes the current role, evidence base, limitations, and future directions of multimodality noninvasive imaging in CAD, providing a practical framework for selecting the appropriate test according to the clinical question and patient profile.
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Hoyek et al. (2026) conducted a review in Coronary artery disease. Multimodality noninvasive cardiovascular imaging (CACS, CCTA, CT-FFR, CTP, stress echocardiography, SPECT, PET, and CMR) vs. Exercise electrocardiography, invasive coronary angiography, or alternative noninvasive imaging modalities was evaluated. Multimodality noninvasive imaging integrates coronary anatomy, plaque burden, physiology, perfusion, and viability to guide patient-specific CAD evaluation and downstream management.
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