transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2025-12-3-225-237SNYVEQtransmed-939Research ArticleКАРДИОЛОГИЯCARDIOLOGYКомпьютерно-томографическая коронарная ангиография: современные возможности методики и место в повседневной клинической практикеCoronary computed tomography angiography: modern capabilities of the technique and place in everyday clinical practicehttps://orcid.org/0000-0002-5457-2683КозулинВ. Ю.KozulinV. Yu.

Козулин Викентий Юрьевич, к.м.н., врач по рентгенэндоваскулярным диагностике и лечению отделения рентгенохирургических методов диагностики и лечения, доцент кафедры кардиологии с клиникой Института медицинского образования 

Санкт-Петербург 

Vikenty Yu. Kozulin, PhD, doctor in X-ray endovascular diagnostics and treatment of the Department of X-ray surgical methods of diagnosis and treatment, Associate Professor of the Cardiology Department 

Saint Petersburg 

kozulinu@yahoo.comhttps://orcid.org/0000-0001-9528-9377АлексееваД. В.АlekseevaDaria

Алексеева Дарья Владимировна, ассистент кафедры лучевой диагностики и медицинской визуализации с клиникой Института медицинского образования, врач-рентгенолог, заведующая отделением лучевой диагностики № 1 

Санкт-Петербург 

Daria V. Аlekseeva, assistant, Radiology and Medical Visualisation Department, radiologist, Head of the Radiology Department No 1 

Saint Petersburg 

darja-karpova@yandex.ruhttps://orcid.org/0000-0003-4442-7228БасекИ. В.BasekI. V.

Басек Илона Владимировна, к.м.н., доцент кафедры лучевой диагностики и медицинской визуализации с клиникой Института медицинского образования, врач-рентгенолог, заведующая отделом лучевой диагностики 

Санкт-Петербург 

Ilona V. Basek, PhD, Associate Professor of the Radiology and Medical Visualisation Department, radiologist, Head of the Department of Radiolody 

Saint Petersburg 

ilona.basek@mail.ruhttps://orcid.org/0000-0002-2111-0765КудаевЮ. А.KudaevY. A.

Кудаев Юрий Анатольевич, к.м.н., научный сотрудник научно-исследовательского отдела ишемической болезни сердца Института сердца и сосудов 

 ул. Аккуратова, д. 2, Санкт-Петербург, 197341 

Yuriy A. Kudaev, PhD, Researcher Department of Ischemic Heart Disease 

Akkuratova str., 2, Saint Petersburg, 197341 

kudaev51@mail.ruhttps://orcid.org/0000-0001-5607-8550ГаляутдиноваЛ. Э.GalyautdinovaL. E.

Галяутдинова Лина Эриковна, ординатор кафедры лучевой диагностики и медицинской визуализации с клиникой Института медицинского образования 

Санкт-Петербург 

Lina E. Galyautdinova, resident, Radiology and Medical Visualization Department 

Saint Petersburg 

Lina_erikovna@mail.ruhttps://orcid.org/0000-0002-1611-5000ТруфановГ. Е.TrufanovG. E.

Труфанов Геннадий Евгеньевич, д.м.н., профессор, заведующий кафедрой лучевой диагностики и медицинской визуализации с клиникой Института медицинского образования 

Санкт-Петербург 

Gennady E. Trufanov, MD, Professor, Head of the Radiology and Medical Visualisation Department 

Saint Petersburg 

Trufanovge@mail.ruhttps://orcid.org/0000-0003-3356-3873ПановА. В.PanovA. V.

Панов Алексей Владимирович, д.м.н., профессор, главный научный сотрудник научно-исследовательского отдела ишемической болезни сердца Института сердца и сосудов 

Санкт-Петербург 

Aleksey V. Panov, MD, Professor, Chief Researcher Department of Ischemic Heart Disease 

Saint Petersburg 

panov_av@almazovcentre.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр им. В.А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian Federation202521082025123225237Copyright © Козулин В.Ю., Алексеева Д.В., Басек И.В., Кудаев Ю.А., Галяутдинова Л.Э., Труфанов Г.Е., Панов А.В., 20252025Козулин В.Ю., Алексеева Д.В., Басек И.В., Кудаев Ю.А., Галяутдинова Л.Э., Труфанов Г.Е., Панов А.В.Kozulin V.Y., Аlekseeva D., Basek I.V., Kudaev Y.A., Galyautdinova L.E., Trufanov G.E., Panov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/939

Ишемическая болезнь сердца (ИБС) остается ведущей причиной смертности во всем мире. В то время как инвазивная коронароангиография является золотым стандартом визуализации просвета сосудов, ее диагностические возможности ограничены в морфологической оценке атеросклеротической бляшки. Компьютерно-томографическая коронарная ангиография (КТ-КГ) предлагает неинвазивную альтернативу, позволяя детально анализировать как анатомию коронарных артерий, так и структурные характеристики бляшки, что критически важно для определения ее нестабильности и вероятности разрыва. Современные технологии КТ, включая динамическую КТ-перфузию и КТ-фракционный резерв кровотока (КТ-ФРК), дополнительно расширяют возможности КТ-КГ, предоставляя функциональную оценку коронарного атеросклероза. Существующие клинические рекомендации рассматривают КТ-КГ как один из первых специфических неинвазивных методов верификации ИБС, особенно у пациентов с подозрением на стабильную ИБС, и с умеренной предтестовой вероятностью. Данный всеобъемлющий обзор освещает актуальные диагностические возможности КТ-КГ, включая ее роль в оценке анатомической тяжести и морфологии бляшек. В нем подробно описана стандартизированная система отчетности результатов исследования (CAD-RADS), обсуждается применение КТ-ФРК и КТ-перфузии для функциональной оценки стенозов, а также рассматриваются технические ограничения и способы их нивелирования. Статья подчеркивает растущую значимость КТ-КГ в персонализированной медицине и оптимизации маршрутизации пациентов.

Coronary artery disease (CAD) remains the leading cause of death worldwide. While invasive coronary angiography is the gold standard for lumen visualization, it falls short in morphological assessment of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) offers a non-invasive alternative, enabling detailed analysis of coronary artery anatomy and structural plaque characteristics crucial for determining instability and rupture risk. Modern computed tomography (CT) technologies, including dynamic CT perfusion and CT-fractional flow reserve (FFRCT), further enhance CCTA by providing functional assessment of coronary atherosclerosis. Current clinical guidelines position CCTA as a primary non-invasive method for CAD verification, particularly for patients with suspected stable CAD and intermediate pre-test probability. This comprehensive review elucidates the contemporary diagnostic capabilities of CCTA, including its role in assessing anatomical severity and plaque morphology. It details the standardized CAD-RADS reporting system, discusses the utility of FFRCT and CT perfusion for functional stenosis evaluation, and addresses technical limitations and their mitigation. The article emphasizes CCTA’s growing importance in personalized medicine and optimizing patient management pathways.

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The authors declare that there are no conflicts of interest present.