Cardiac CT's expanding role gives radiologists new opportunities
Radiologists should be paying closer attention to cardiac CT as advances in technology, clinical guidelines and artificial intelligence expand the role of coronary imaging, according to Suhny Abbara, MD, senior associate consultant and professor of radiology at Mayo Clinic in Jacksonville, Florida.
Abbara, a cardiac imager, also became one of the largest public faces of radiology in January when he took over as editor of the RSNA journal Radiology. He believes coronary imaging represents an important growth area for radiology, even as the specialty continues to embrace advances across all imaging disciplines. Abbara spoke with Radiology Business in the above video at the 2026 Society of Cardiovascular Computed Tomography (SCCT) meeting, an organization he served as a past-president.
“Radiology is open for business when it comes to cardiac imaging,” Abbara said, emphasizing that this includes both coronary CT and cardiac MRI.
The transformation of coronary CT over the past two decades has been substantial, he said. Modern scanners provide dramatically improved spatial and temporal resolution while radiation exposure has fallen significantly. At the same time, positive reimbursement changes and the incorporation of coronary CT angiography (CCTA) into 2021 chest pain guidelines have helped drive broader clinical adoption.
Abbara believes the next phase will move CCTA beyond evaluating patients who already have suspected or established disease, toward earlier detection and prevention. This will likely include the use of AI opportunistic imaging where the heart and vascular systems are evaluated from a variety of radiology CT scans that are ordered for noncardiac reasons.
“We are just at the beginning of using all the information that is provided to us by cardiac CT,” he said.
One major opportunity is incidental detection of coronary atherosclerosis on CT examinations performed for other clinical reasons. Abbara said both noncontrast and contrast-enhanced chest CT can provide information about coronary disease that might otherwise go unrecognized. The goal is to identify atherosclerosis earlier, potentially giving patients more years in which preventive measures such as lipid-lowering therapy and lifestyle changes can reduce cardiovascular risk.
AI could further expand this opportunity by quantifying coronary plaque and other markers of disease on routine CT examinations. Abbara said there is growing evidence showing that imaging of atherosclerosis can influence both patient and physician behavior.
"So, seeing is believing," he said. "If you show me that I have plaque in my coronary arteries, be it a calcified plaque through a calcium scoring CT or more sophisticated plaque analysis through AI quantification, I'm going to take a moment and I am much more likely to really make changes for the better. Seeing incidental plaque on a chest CT is definitive proof of coronary artery atherosclerotic disease. And evidence shows that patient behavior and physician behaviors change if you share the documentation of atherosclerosis with them, especially in an image from cardiac CT."
Visual evidence also is helpful to explain why preventive therapies such as statins might be needed.
Abbara said radiology already plays an important role because coronary findings can be incorporated into imaging reports. He said radiology and referring physicians often have a disconnect between incidental findings and taking the next steps to execute followup. The challenge for radiology is the need for greater effort to make sure those findings translate into action. AI might be able to help with this.
As cardiac CT continues moving toward prevention, radiologists who traditionally have focused on interpreting chest examinations may increasingly become part of cardiovascular risk detection. Abbara said the field should embrace that opportunity and ensure radiology remains an active participant in the expanding use of coronary imaging.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]