The Role of Computed Tomography in High-Risk Coronary Plaque: From Imaging Assessment to Prognostic Implications.

Abstract

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.