Cardiac CT offers a clearer picture of CVD
Advances in imaging move beyond coronary narrowing to reveal disease activity, characterize myocardial tissue and refine diagnosis.
Cardiac computed tomography has long been an important tool for assessing coronary luminal stenosis, but recent advances are expanding its use to a more comprehensive evaluation of coronary inflammation, myocardial tissue characteristics and disease processes particularly relevant to women.
A Sunday joint session with the American Heart Association and the Society of Cardiovascular Computed Tomography, “New Horizons in Cardiac Computed Tomography: American Heart Association Joint Session With Society of Cardiovascular Computed Tomography,” will explore this evolution by highlighting how advances in cardiac CT can improve risk assessment, refine diagnosis and potentially support more personalized patient management.
Diana Litmanovich, MD, FNASCI, council chair of the Cardiovascular Radiology and Intervention Council, is moderating the session. She is an associate professor of radiology at Harvard Medical School in Boston. Litmanovich said the session will highlight three complementary areas involving emerging imaging biomarkers and techniques that may improve disease characterization and enhance risk stratification:
- Pericoronary adipose tissue attenuation
- CT-based myocardial tissue characterization
- Imaging of spontaneous coronary artery dissection (SCAD)
Litmanovich, who is also vice chair of practitioner and population health at Beth Israel Deaconess Medical Center in Boston, said pericoronary adipose tissue attenuation is an emerging biomarker that provides insight into coronary inflammation and may offer information about coronary atherosclerotic activity beyond conventional anatomic assessment.
“It represents a shift toward characterizing the biological activity of coronary artery disease, rather than simply measuring the degree of luminal narrowing,” she said.
Litmanovich said this part of the discussion will highlight the gap between research applications and clinical use, focusing on two main questions:
- Can coronary artery CT tell us something about the activity and vulnerability of atherosclerotic disease beyond what we see in the lumen and plaque?
- Can inflammation be detected when the coronary lumen appears to be normal?
In the area of CT-based myocardial tissue characterization, Litmanovich said advances in CT acquisition, reconstruction and quantitative analysis are expanding the potential to characterize myocardial tissue beyond conventional morphology and function.
“These developments may improve the evaluation of myocardial disease, complement cardiac MRI and broaden the clinical applications of cardiac CT,” she said.
Litmanovich, whose research focuses in part on cardiovascular disease in women, said greater understanding of its distinct presentations and mechanisms is driving interest in tailored imaging strategies, including those used for SCAD.
“The session will address the role of cardiac imaging in evaluating SCAD and other important manifestations of cardiovascular disease in women, where diagnosis and management may differ from those of more typical atherosclerotic coronary disease,” she said.
Litmanovich said the session will offer several practical takeaways that attendees can apply in their clinical settings. These include:
- Recognizing the potential clinical significance and current limitations of pericoronary adipose tissue attenuation as a marker of coronary inflammation
- Understanding the principles, potential applications and interpretive considerations of CT-based myocardial tissue characterization
- Recognizing important imaging considerations in patients with suspected or established SCAD and other cardiovascular conditions that disproportionately affect women
- Identifying clinical scenarios in which advanced CT techniques may provide additional information beyond conventional coronary anatomy
- Critically assessing current evidence, technical limitations and remaining research questions that influence the transition of emerging techniques into routine practice
“In bringing together emerging biomarkers, novel tissue-characterization techniques and a focused discussion of cardiovascular disease in women, this session illustrates the expanding potential of cardiac CT to answer questions that were previously difficult to address with conventional imaging alone,” Litmanovich said.
