CCTA highlights plaque regression due to treatment
Coronary CT angiography (CCTA) is emerging as a powerful tool not only for diagnosing coronary artery disease, but also for tracking how patients respond to preventive therapies over time. That's according to Mark G. Rabbat, MD, professor of medicine and radiology and director of cardiac imaging at Loyola University Medical Center.
Speaking at SCCT2026, the Society of Cardiovascular Computed Tomography (SCCT) annual meeting, Rabbat said advances in CT imaging and artificial intelligence (AI) now allow physicians to precisely measure changes in coronary plaque, providing a more individualized way to monitor disease progression—or regression—and guide treatment decisions.
"We've moved far beyond stenosis now," Rabbat said. "We're able to look at plaque features, morphology, plaque phenotype, burden of disease, physiology and lesion-specific physiology. What we're seeing over time is less progression in many of our patients where we're escalating preventive therapies, becoming more aggressive with lifestyle modification and, in some cases, even seeing slight regression."
Unlike traditional imaging focused on narrowing of the coronary arteries, modern CCTA can evaluate both calcified and non-calcified plaque. The low-attenuation plaque has been linked to a higher risk of cardiovascular events.
Rabbat said these detailed assessments can be obtained from a CT scan, and repeated over time to measure changes in plaque burden.
"Now we have a way noninvasively to assess progression of disease, regression of disease and response to therapies over time," he said.
Artificial intelligence is playing a key role by providing precise plaque measurements in cubic millimeters and quantifying plaque composition, replacing the subjective visual comparisons physicians previously relied on that did not incorporate detailed measurements.
"Now we're very precise in our objective metrics," Rabbat said. "No more guesswork. The disease is atherosclerosis, and we can quantify that now."
He believes the technology represents a major advance for preventive cardiology because it shifts the focus away from surrogate markers such as LDL cholesterol alone and toward directly measuring the disease itself to personalize treatments for each patient. The approach also exposes shortcomings in traditional cardiovascular risk calculators, which estimate risk based on population statistics, but may not accurately identify individual patients with significant disease.
Rabbat said his team presented data at SCCT2026 showing many patients categorized as low risk by conventional atherosclerotic cardiovascular disease (ASCVD) risk calculators were found on CCTA to have severe or extensive plaque.
"Currently it's oftentimes failing to inform," he said of current standard of care risk assessments.
Instead, AI plaque analysis is enabling clinicians to stage coronary artery disease in a manner similar to cancer or chronic kidney disease, allowing therapy to be tailored according to actual disease severity, rather than risk factors alone.
At Loyola, Rabbat said AI plaque analysis is routinely performed in most patients with evidence of coronary atherosclerosis, particularly those with 1% to 70% coronary stenosis, creating a quantitative baseline for future comparisons. The AI component enables more accuracy, because plaque burden and the impact of the arterial narrowing often do not correlate. He said some patients exhibiting extensive plaque might show only mild hemodynamic impact when FFR-CT is used to see the physiology.
Perhaps most surprising, Rabbat said his team published research showing measurable plaque changes can occur within just nine months after initiating lipid-lowering therapy.[1]
"I honestly didn't realize that we'd be seeing these effects as early as nine months," he said. "It was very humbling."
As evidence continues to grow, Rabbat believes AI-assisted CCTA will become an increasingly important tool for personalizing preventive cardiovascular care, enabling clinicians to identify patients needing more aggressive treatment while documenting when therapies are successfully slowing—or reversing—the progression of atherosclerosis.
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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]