Imaging Biomarkers for ASCVD Screening: CAC, CTA, and Opportunistic Findings

CAC scoring remains the most established imaging biomarker for ASCVD risk reclassification; coronary CT angiography adds plaque burden and high-risk features. Opportunistic CT/MRI findings (incidental calcifications, hepatic steatosis, etc.) extend risk assessment without extra…

• Coronary artery calcium scoring on noncontrast ECG-gated CT is the guideline-endorsed standard for refining risk in borderline- and intermediate-risk patients.
• Coronary CTA provides incremental value through plaque burden, composition, and high-risk features, with emerging quantitative plaque and pericoronary fat analysis.
• Routine chest and abdominal CT or MRI can opportunistically capture cardiovascular risk from findings like breast arterial calcification, visceral adiposity, sarcopenia, and liver fat.

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