Calcified plaque: the Achilles' Heel of present computed tomography coronary angiography for the elderly?

Nine percent to 27% of cardiac catheterizations today showed either angiographic normal coronary arteries or minimal atherosclerosis. '?2 Given the expense of cardiac catheterization and the desire to use this valuable resource for therapeutic rather than diagnostic purpose, there is a strong impetus to develop non-invasive means of accurately detecting significant coronary artery stenosis. Although echocardiography is the most common non-invasive cardiac procedure, nuclear cardiology, more recently cardiac computed tomography angiography (CTA) and cardiac magnetic resonance (CMR) play more important roles in detecting significant coronary artery disease. While CMR had great promise as a radiation-free and contrast-free 'one-stop' procedure, its technology currently lags behind CTA in the non-invasive imaging of coronary artery.