CT Coronary Angiography

Non-invasive CT imaging of the coronary arteries using contrast dye to visualise blockages, narrowing, soft plaques, and anomalies in precise three-dimensional detail — without catheter insertion or hospitalisation.

CT coronary angiography at KardioRadiologie Köln uses a 256-slice scanner with a rotation time of 270 milliseconds to capture high-resolution, three-dimensional images of the coronary arterial tree in a single breath-hold. Unlike a conventional cardiac catheterisation, no catheter is threaded through the groin or arm; instead, an intravenous line delivers iodine-based contrast dye moments before the scanner acquires images as the contrast bolus perfuses the coronary circulation. The examination detects not only calcified plaques — which appear as dense bright spots — but also the softer, lipid-rich plaques that do not calcify and are therefore invisible to calcium scoring alone. It is precisely these non-calcified plaques that carry the greatest risk of sudden rupture and acute myocardial infarction, making CT coronary angiography a more comprehensive risk assessment tool than calcium scoring in isolation. Following acquisition, the radiologist processes the raw data using multi-planar and three-dimensional reconstructions that display each coronary artery individually from multiple angles. Vessel narrowing (stenosis) is graded by its estimated percentage reduction in luminal diameter; the location, length, and composition of any stenosis are documented in the findings report. Additional findings such as coronary anomalies — vessels that arise from abnormal positions and may cause exertional chest pain — are also identifiable. The entire examination is conducted without hospitalisation; patients arrive, undergo the scan, receive a consultation, and leave the same day. PD Dr. Klass conducts a preparatory conversation before every examination to tailor the scanning protocol to the specific clinical question, then reviews findings directly with the patient after the scan. KardioRadiologie Köln offers CT coronary angiography as a standalone investigation and in combination with calcium scoring, which is typically performed first as part of the same appointment. The combined approach is particularly powerful: the calcium score provides a total atherosclerotic burden index, while the angiogram maps the coronary tree to identify whether any calcified or non-calcified plaques are causing haemodynamically significant narrowing that would warrant further management. Prepare for the examination by avoiding caffeine, chocolate, nicotine, and bananas for 24 hours beforehand, as these substances raise heart rate and reduce scan quality. Current kidney function and thyroid values (creatinine and TSH, no older than six weeks) are required before contrast administration. Patients taking metformin or PDE-5 inhibitors should follow specific discontinuation guidance from the practice. No fasting is required for the scan itself, though some contrast agent protocols recommend a light meal beforehand. Private health insurance (PKV) reimburses the full cost of CT coronary angiography for preventive screening in the vast majority of cases. Since January 2025, German statutory health insurance (GKV) covers the examination for patients with a pre-test probability of coronary artery disease between 15 and 50 percent under the updated benefit catalogue. Self-pay patients may book without a referral.