Coronary CT angiography: a guide to examination, interpretation, and clinical indications

A decade ago, the workup for suspected coronary disease usually meant a stress test first and a direct look at the arteries only later. This expert review documents the reversal: coronary CT angiography, it argues, belongs first.

CCTA is a non-invasive scan that renders the coronary arteries in anatomic detail — showing not just whether a vessel is narrowed but the plaque lining its walls. The review walks through technique, interpretation, and the clinical situations where CCTA earns its place as the front-line test, with functional testing reserved for when an anatomic finding needs its significance confirmed.

The practical message: for many patients with suspected stable disease, start with the picture. The resistance is structural — invasive and nuclear practitioners face a shift in both workflow and revenue when the first test moves to CT.

We rate the evidence moderate. This is an expert narrative review — wide authorship, 56 references — consolidating accepted practice rather than generating new data, and it predates some of the strongest outcome evidence for a CT-first strategy. Its clinical significance is moderate and has aged well: CCTA-first has since moved decisively into guidelines. A solid orientation to a modality that has become central, not a trial that proves the case on its own.