Can Ultra-High Resolution CT replace Invasive Coronary Angiography?
For nearly two decades, the CORE studies, funded by Canon, have helped define the role of cardiac CT in the diagnosis and management of coronary artery disease. CORE PRECISION represents the next step in that scientific journey: testing whether UHR-CT can match invasive angiography in high-risk patients.

The CORE PRECISION trial (NCT04272060: https://clinicaltrials.gov/ct2/show/NCT04272060) is the first international, multicenter, prospective diagnostic accuracy study designed to answer this question in one of the most challenging patient populations: individuals with established CAD, severe coronary calcifications, or prior stents.

It compares the diagnostic performance of UHR-CT and ICA to determine hemodynamically relevant lesions as assessed by quantitative flow ratio (QFR) and was recently presented at the 2026 American College of Cardiology Scientific Sessions.

Worldwide collaboration
The study, led by Prof. Armin Zadeh MD, PhD, director of cardiac CT and Professor of Medicine and Biomedical Engineering at The Johns Hopkins University School of Medicine, Baltimore, involved three international study sites:

• The Johns Hopkins University School of Medicine, Baltimore, USA,
• Iwate Medical University Hospital, Iwate, Japan,
• Einstein Hospital Israelita, Sao Paulo, Brazil.

Study protocol
Patients underwent a research UHR-CT scan using the Aquilion Precision. This technology has a 0.25 mm detector width (twice the spatial resolution of conventional CT) and 160 × 0.25 mm collimation. Images were reconstructed with a 1024 × 1024 matrix using Deep Learning Reconstruction (Advanced intelligent Clear-IQ Engine (AiCE)). Patients also underwent invasive coronary angiography. Both the CT and ICA images were assessed for the presence of significant (≥70%) stenosis. Quantitative flow ratio (QFR) was derived from the ICA images and served as the gold standard to assess the physiological significance of coronary artery blockages. This approach was chosen to be aligned with contemporary management and allowed to directly compare CT and ICA to a functional standard. Read more about the methods here.

Main findings
In patients with severely calcified coronary arteries, Ultra-High Resolution CT (UHR-CT) yields similar diagnostic accuracy to invasive coronary angiography (ICA) in detecting patients with hemodynamically significant coronary artery disease (CAD).

Images from all three modalities were available for 173 patients. The average calcium score in patients without stents (n=124) was 955 (± 1080). Significant coronary artery disease by QFR was present in 115 patients (66%). The diagnostic accuracy of UHR-CT was 80.3% (95% CI: 73.6-86.0), compared to 83.2% (95% CI: 76.8-88.5) for ICA (p=0.38; 0.18 for non-inferiority). Among patients with all three vessels evaluated (n=135), accuracy was 81.5% for UHRCT and 83.0% for ICA (p=0.68). In patients with a calcium score <1,000 (n=86), the accuracy for both tests was the same at 82.6%.

Implications for patients
This is the first worldwide prospective multi-center study of UHR coronary CT angiography in patients with severely calcified vessels and stents. The comparable diagnostic accuracies of ICA and UHR-CT in a population previously deemed unsuitable for CT, support UHR-CT as a valid, noninvasive alternative to ICA for diagnosing significant coronary artery disease. In other words, even these challenging patients may not always need to undergo an invasive test anymore.

• RSNA (2022). UHR-CT For Calcified Arterial Lesions | RSNA accessed February 2026.
• Latina J, Shabani M, Kapoor K et al. Ultra-High-Resolution Coronary CT Angiography for Assessment of Patients with Severe Coronary Artery Calcification: Initial Experience. Radiol Cardiothorac Imaging 2021;3:e210053. doi: 10.1148/ryct.2021210053
• Scarpa Matuck BR, Akino N, Bakhshi H et al. Ultra-high-resolution CT vs. invasive angiography for detecting hemodynamically significant coronary artery disease: Rationale and methods of the CORE PRECISION multicenter study. J Cardiovasc Comput Tomogr 2024. doi: 10.1016/j.jcct.2024.04.012
• ACC (2026). ACC 75th Annual Scientific Sessions - ULTRA-HIGH-RESOLUTION CT VERSUS INVASIVE ANGIOGRAPHY FOR DETECTING HEMODYNAMICALLY SIGNIFICANT CORONARY ARTERY DISEASE: THE CORE PRECISION MULTICENTER, INTERNATIONAL STUDY accessed April 2026.