Cardiac CT in the Era of Precision Cardiology: From Calcium Scoring to Comprehensive Risk Profiling.
Authors
Affiliations (7)
Affiliations (7)
- Cardiology Unit, Villa Verde Clinic, 74121 Taranto, Italy.
- Cardiology Unit, Mater Dei Hospital, 70125 Bari, Italy.
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy.
- Radiology Unit, King Saud University, Riyadh 11451, Saudi Arabia.
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy.
- University Cardiology Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy.
- Radiology Unit, University Hospital of Padova, 35128 Padua, Italy.
Abstract
Cardiac computed tomography (CT) has evolved into a pivotal tool in precision cardiology, enabling comprehensive, non-invasive evaluation of coronary anatomy, plaque composition, vascular function, and inflammation. From calcium scoring to advanced physiological imaging, CT now integrates multiple layers of cardiovascular information within a unified diagnostic framework. Coronary artery calcium (CAC) quantification provides a robust, reproducible measure of atherosclerotic burden and refines risk estimation beyond traditional algorithms, particularly in asymptomatic individuals with an intermediate likelihood. Building upon this anatomical foundation, coronary CT angiography (CCTA) extends evaluation to the anatomical and morphological characterization of coronary artery disease (CAD), identifying both obstructive and non-obstructive plaques with high prognostic accuracy. The addition of CT-derived fractional flow reserve (FFR-CT) and stress perfusion CT (CTP) bridges anatomy and physiology, improving identification of flow-limiting stenoses and guiding revascularization decisions while reducing unnecessary invasive procedures. Beyond luminal assessment, CT-derived biomarkers such as the perivascular fat attenuation index (pFAI) have introduced a new dimension of vascular inflammation imaging, revealing residual risk even in patients without significant stenosis and suggesting novel pathways for individualized therapeutic targeting. Driven by advances in artificial intelligence and photon-counting detector technology, cardiac CT is transitioning from a purely diagnostic modality to an integrative platform for cardiovascular phenotyping. Taken as a whole, this integration of structural, functional, and biological data provides a genuinely holistic view of coronary health. In practical terms, it shifts clinical decision-making from population-based risk models toward precision-guided patient-specific strategies.