High Risk Plaque Features on Coronary CT Angiography
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Coronary computed tomography angiography (CCTA) is a non-invasive imaging technique that can detect, characterize and quantify coronary atherosclerotic plaques in routine clinical settings. The distinct morphological features of vulnerable plaques and stable lesions provide an opportunity for CCTA to identify high-risk plaque features and guide stratified therapeutic interventions. Morphological plaque characteristics, such as large plaque volume, positive remodelling, low CT attenuation, spotty calcification and the napkin-ring sign have been linked to elevated risk of acute coronary syndrome. Recent advances in computational fluid dynamics enabled functional plaque assessment through endothelial shear stress and lesion specific fractional flow reserve calculation. The comprehensive, morphological and functional plaque assessment may improve the identification of vulnerable coronary lesions.