Advances in the assessment of coronary artery disease activity with PET/CT and CTA

Most cardiac imaging asks whether an artery is narrowed. This review covers a newer question: whether the disease is active — inflamed and dangerous right now — using PET and CT in tandem.

Two markers anchor it. A PET tracer, 18F-sodium fluoride, lights up the microcalcification in plaque that is actively progressing; and a CT measure of the fat around the coronary arteries (pericoronary adipose tissue density) reflects inflammation in the vessel wall. Together they add predictive power beyond the usual anatomy-and-perfusion picture, flagging high-risk plaque before it ruptures.

The practical takeaway is the prospect of imaging disease activity to catch dangerous plaque earlier and target therapy more precisely. The resistance is the inertia of perfusion- and stenosis-based imaging, plus the cost and training these molecular techniques demand.

We rate the evidence moderate: a 74-reference, conflict-free narrative review, but of techniques that remain largely research tools. Its clinical significance is moderate and emerging — a genuinely promising direction for risk stratification that is not yet part of routine practice.