Fukui Rika, Harashima Shingo, Samejima Wakana, Shimizu Yuta, Washizuka Fuyuki, Kariyasu Toshiya, Nishikawa Makiko, Yamaguchi Hidenori, Takeuchi Hitoshi, Machida Haruhiko
From the Department of Radiology, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kohoku, Adachi-ku, Tokyo 123-8558, Japan (R.F., S.H., W.S., T.K., M.N., H.Y., H.M.); Department of Radiology, Kyorin University Hospital, Tokyo, Japan (Y.S.); Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan (F.W.); and Department of Radiology, Fukujuji Hospital, Tokyo, Japan (H.T.).
Radiographics. 2025 Jul;45(7):e240083. doi: 10.1148/rg.240083.
Coronary CT angiography (CCTA) has been widely used as a noninvasive modality for accurate assessment of coronary artery disease (CAD) in clinical settings. However, the following limitations of CCTA remain issues of interest: motion, stair-step, and blooming artifacts; suboptimal image noise; ionizing radiation exposure; administration of contrast medium; and complex imaging workflow. Various acquisition and reconstruction techniques have been introduced over the past decade to overcome these limitations. Low-tube-voltage acquisition using a high-output x-ray tube can reasonably reduce the contrast medium and radiation dose. Fast x-ray tube and gantry rotation, dual-source CT, and a motion-correction algorithm (MCA) can improve temporal resolution and reduce coronary motion artifacts. High-definition CT (HDCT), ultrahigh-resolution CT (UHRCT), and superresolution deep learning reconstruction (DLR) algorithms can improve the spatial resolution and delineation of the vessel lumen with coronary calcifications or stents by reducing blooming artifacts. Whole-heart coverage using area-detector CT can eliminate stair-step artifacts. The DLR algorithm can effectively reduce image noise and radiation dose while maintaining image quality, particularly during high-resolution acquisition using HDCT or UHRCT, during low-tube-voltage acquisition, or when imaging patients with a large body habitus. Automatic cardiac protocol selection, automatic optimal cardiac phase selection, and MCA can improve the imaging workflow for each CCTA examination. A sufficient understanding of current and novel acquisition and reconstruction techniques is important to enhance the clinical value of CCTA for noninvasive assessment of CAD. RSNA, 2025 Supplemental material is available for this article.
