The role of CT angiography in risk stratification for atherosclerosis.

Multislice CT coronary angiography (CTA) offers the opportunity to visualize the coronary arteries in a complete fashion, including the arterial wall, vessel dimensions and tortuosity, and calcified and noncalcified plaques. The ability of CTA to reliably rule out high-grade stenoses in patients with an intermediate likelihood of coronary artery disease has been well established. Recently, CTA applications have been extended to interrogate coronary plaques in more detail. In patients with acute coronary syndrome, culprit plaques were observed to have a larger volume, less solid but spottier calcification, and an increased tendency for expansive (positive) remodeling. A number of prospective studies have suggested that the quantification of overall coronary atherosclerosis adds incremental prognostic power in addition to conventional risk factor analysis. With novel scanning algorithms promising a substantial radiation dose reduction, risk stratification for coronary atherosclerosis by using CTA may become an option in selected patients. It is still undetermined if this method offers a prognostic benefit over conventional methods and how it compares to calcium scoring. The currently available data are encouraging.