The Role of Computed Tomography in High‐Risk Coronary Plaque: From Imaging Assessment to Prognostic Implications
High-risk coronary plaque underlies major adverse cardiovascular events, shifting coronary imaging beyond luminal stenosis toward plaque characterization. CCTA identifies vulnerable features including low-attenuation plaque, positive remodeling, spotty calcifications, and napkin-ring sign, while enabling quantification of plaque burden and composition. Dual-energy and photon-counting CT improve tissue characterization, whereas AI and radiomics support automated analysis. Integration with FFR-CT and CT or MR perfusion imaging links plaque vulnerability with functional ischemia. Beyond diagnosis, CCTA enables longitudinal monitoring of plaque remodeling and stabilization under therapy. This review summarizes the role of CCTA in risk stratification, therapeutic monitoring, and personalized coronary artery disease management.
Authors
- Marianna Mirchuk (ORCID: https://orcid.org/0000-0003-1253-1776)
- Aldo Carnevale (ORCID: https://orcid.org/0000-0001-8191-6042)
- Long Jiang Zhang (ORCID: https://orcid.org/0000-0002-6664-7224)
- Alberto Cossu (ORCID: https://orcid.org/0000-0002-3462-1695)
- Nicola Pegoraro (ORCID: https://orcid.org/0009-0007-3637-0109)
- Hongjie Hu (ORCID: https://orcid.org/0000-0002-9859-5860)
- Giuseppe Muscogiuri (ORCID: https://orcid.org/0000-0003-4757-2420)
- Tilman Emrich (ORCID: https://orcid.org/0000-0003-4156-7727)
- Akos Varga‐Szemes
- Milan Vecsey‐Nagy
Institutions
- Semmelweis University (HU)
- Medical University of South Carolina (US)
- Johannes Gutenberg University Mainz (DE)
- University of Ferrara (IT)
- Danylo Halytsky Lviv National Medical University (UA)
- Sir Run Run Shaw Hospital (CN)
- Karolinska Institutet (SE)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- Ospedale Papa Giovanni XXIII (IT)
- Institute of Blood Pathology and Transfusion Medicine of the National Academy of Medical Sciences of Ukraine (UA)
- Arcispedale Sant'Anna (IT)
- German Centre for Cardiovascular Research (DE)
- Second Affiliated Hospital of Nanjing Medical University (CN)
- University of Milano-Bicocca (IT)
- Nanjing Medical University (CN)
Publication Details
- Journal
- Journal of Clinical Ultrasound
- Published
- 2026-07-30
- DOI
- https://doi.org/10.1002/jcu.70351
- Primary Topic
- Cardiac Imaging and Diagnostics
- Type
- article
- Field-Weighted Citation Impact
- 0.00