How Early Can Atherosclerosis Be Detected by Coronary CT Angiography? Insights From the PARADIGM Trial

If atherosclerosis is best caught early, the question becomes: how small a plaque can imaging reliably find and follow? This analysis from the PARADIGM trial used AI-driven quantitative CT to look at the very earliest lesions across serial scans.

Tracking small coronary plaques over time, the investigators found that 87 percent of them were still identifiable at the same location on follow-up — confirming these were real, reproducible findings rather than noise — and that 72 percent had grown in volume. In other words, tiny non-obstructive plaques are both detectable and dynamic, often progressing if left alone.

The implication supports the early-detection premise: CT angiography, especially with quantitative analysis, can spot atherosclerosis at a stage when there is no narrowing and no symptom, and that early disease tends to advance. It strengthens the rationale for finding and treating subclinical plaque before it matures.

We rate the evidence moderate-to-strong. The sample is small and the design retrospective, but it leverages serial imaging and automated quantification to make a specific, useful point about how early disease can be seen and that it rarely stands still.