Cardiac CT Diagnostic and Clinical Pitfalls: Practical Insights

Cardiac CT angiography is now the most widely used non-invasive test for coronary artery disease, structural heart disease planning, and cardiomyopathy workup. Its clinical power is validated by landmark trials including SCOT-HEART, PROMISE, and DISCHARGE. Yet missed stenosis, overcalled lesions, artefacts misread as pathology, incidental findings lost to follow-up, and reports that fail to communicate urgency continue to drive adverse outcomes, unnecessary invasive procedures, and medicolegal claims worldwide.

Cardiac CT: Diagnostic and Clinical Pitfalls — Practical Insights is the definitive practical guide to recognising, avoiding, and documenting the interpretive errors that matter most in cardiac CT. Written by an experienced cardiac imaging specialist, it takes a pitfall-first approach across all domains — from acquisition and artefact through coronary anatomy, stenosis assessment, structural findings, emergency presentations, and AI-assisted workflows — equipping readers with systematic skills to distinguish genuine pathology from imitation and communicate findings with precision and medicolegal rigour.

What this book covers:

·      Acquisition and artefact: Motion, phase step, staircase artefacts, calcium blooming, SVC streak, pulsation artefacts, beam hardening, contrast flow — with mechanism, appearance, clinical mimic, and correction

·      Calcium scoring: AI attribution errors, mitral annular/aortic valve misattribution, photon-counting CT recalibration, Agatston verification

·      Coronary anatomy variants: Anomalous origins, myocardial bridging, ramus intermedius, absent RCA, duplicate LAD — and consequences of misidentification

·      Stenosis pitfalls: Calcium blooming overcall, non-assessable segments, CAD-RADS 2.0, high-risk plaque, diffuse disease, post-CABG/stent assessment

·      FFR-CT: Grey zones, calcified vessels, multi-vessel disease, serial errors, confidence miscalibration, invasive discordance

·      Structural heart disease: Pre-TAVR/MitraClip CT, LAA thrombus vs pseudothrombus, ARVC, constrictive pericarditis, myocardial fat

·      Emergency findings: Aortic dissection, ACS on CT, PE vs TIC artefact, haemopericardium, SCAD

·      AI workflows: Automation bias, distribution shift, confidence miscalibration, FFR-CT limits, safe workflow design

·      Reporting: Structured reporting, CAD-RADS 2.0, critical findings, incidental findings, Category A/B/C

·      Medicolegal: Documenting uncertainty, calibrated language, overread management, evidence-based recommendations

·      50 teaching cases: Rapid case review across artefact, anatomy, stenosis, structural, emergency, AI, and medicolegal scenarios

Features include:

·      Decision algorithms

·      Recommended acquisition protocols

·      Quick-reference artefact recognition

·      HU reference table

·      Urgency communication guide

Written for cardiologists, radiologists, imaging fellows, radiographers, and cardiac surgery/electrophysiology teams. Suitable for training, reporting support, and exam preparation, it delivers practical, structured, evidence-based guidance for cardiac CT practice.