At the 36th Great Wall Cardiology Conference and the Asian Cardiology Conference 2025, during the “Coronary CTA Reading: A Dialogue Between Imaging and Clinical Experts” forum, Professor Xu Lei from Beijing Anzhen Hospital, Capital Medical University, delivered a systematic and insightful presentation on “How to Master the Principles of Coronary CTA Reading.” He comprehensively presented the core value and practical challenges of coronary CTA in the precise diagnosis of coronary heart disease, covering topics from image reconstruction and artifact recognition to the standardization of clinical interpretation, providing practical guidance for attending imaging and clinical physicians.
Professor Xu emphasized that accurate interpretation of coronary CTA requires a complete understanding of cardiac and coronary anatomy, an in-depth understanding of coronary plaque types and components, the ability to distinguish between coronary and myocardial lesions, and familiarity with cardiac CT technology, its limitations, and the image reconstruction process. Particularly for clinical physicians, image acquisition strategies, reconstruction phase selection, and artifact recognition are often weak links that directly affect the accuracy of stenosis assessment and the reliability of subsequent treatment decisions.
When introducing commonly used image reconstruction methods for coronary CTA, Professor Xu illustrated the applicable scenarios and potential pitfalls of volume rendering, surface reconstruction, and probe images with intuitive cases. While volume rendering can display the three-dimensional structure of the coronary arteries, its value for stenosis interpretation is limited due to significant windowing effects; surface reconstruction can fully present the course of the coronary arteries, but if the centerline is offset, it may lead to misjudgment, thus requiring multi-angle and multi-plane joint assessments; probe images have unique advantages in avoiding post-processing distortion and improving stenosis interpretation accuracy. Professor Xu emphasized that high-quality image quality is a prerequisite for all interpretation work.
Artifacts are significant factors affecting the accurate interpretation by imaging and clinical physicians. Professor Xu detailed several typical cases, showcasing motion artifacts, stair-step artifacts, partial volume effects related to calcification, and the typical imaging manifestations and misleading risks of metal artifacts. For instance, motion artifacts caused by poor heart rate control often obscure the vessel wall and lumen, easily misclassifying originally mild to moderate lesions as severe stenosis; the calcification blooming effect and stent halo artifacts may lead to “pseudo-stent restenosis,” guiding clinical physicians into unnecessary coronary angiography procedures. Additionally, Professor Xu emphasized that the assessment of vascular stent segments in coronary CTA is primarily affected by motion artifacts, halo artifacts, and partial volume effects, with motion artifacts being the most common. It is important to note that visualization of the distal vessel of the stent does not necessarily indicate stent patency, as collateral circulation may also create a false impression, requiring special caution during clinical interpretation. Professor Xu pointed out that selecting the appropriate reconstruction phase and understanding the imaging differences during the cardiac cycle are key to reducing artifact interference and improving diagnostic accuracy.
For the structured reading process of coronary CTA, Professor Xu proposed a method that combines imaging standardization with clinical operability: evaluating each segment of the coronary artery sequentially; integrating cross-sectional and longitudinal views for comprehensive judgment; and conducting a thorough analysis of the lesion location, plaque composition, plaque morphology, extent, density, and involvement based on artifact recognition. While systematically introducing the CAD-RADS 2.0 plaque burden assessment system and the CAD-RADS stenosis grading system, he also pointed out the limitations of the current grading systems, such as the classification of “70% and 99% both categorized as severe stenosis,” which lacks sufficient clinical guidance value and needs to be reinterpreted in conjunction with the nature of the lesions and the comprehensive risk status of the patients.
Through systematic theoretical explanations and high-quality imaging examples, Professor Xu’s presentation not only introduced the basic reading methods for coronary CTA but also deepened the understanding of its important role in the assessment of coronary lesions and clinical decision support, reiterating the necessity of close collaboration between imaging and clinical departments. Coronary CTA has become an indispensable foundational tool, and its true diagnostic value comes from a profound understanding of the imaging technology itself and the precise identification of the nature of the lesions.
GW-ICC/AHS 2025
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