Imaging of Coronary Atherosclerosis with Computed Tomography Coronary Angiography

Coronary atherosclerosis is a worldwide pandemic disease and accounts for almost 17 million deaths annually. The detection and accurate quantification of coronary plaque may potentially improve individualized risk stratification and allow the monitoring of patient’s response to pharmacological treatment. Computed tomography coronary angiography (CTCA) has rapidly emerged as a noninvasive imaging modality for visualisation of the coronary arteries.

In this thesis, the potential of CTCA to detect and quantify coronary atherosclerotic plaque compared to invasive imaging techniques is evaluated. It is envisioned that the ability of CTCA to provide information not currently available from invasive angiography (i.e. plaque burden and calcium score) may change the way patients with atherosclerotic cardiovascular disease are stratified and managed. The accurate and reproducible assessment of atherosclerotic plaque noninvasively is paramount to monitor the progression of disease and the response to pharmacological therapy and quantitative measurements are more reliable when semiautomated software is used. Moreover, the ability of the technique to appreciate the whole coronary tree and the complex 3D geometry of coronary arteries can facilitate the decision-making on the treatment of coronary bifurcation lesions and the risk stratification of patients. The integration of information such as functional significance to the anatomic evaluation of atherosclerosis may serve to add incremental value to the prognostic utility of CTCA.