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The spectrum includes MINOCA and ANOCA/INOCA, linked to clinically important adverse outcomes. Cardiac CT expands assessment from excluding obstructive disease to anatomical, functional, and tissue-level evaluation, quantifying plaque burden, identifying high-risk features, and enabling CT-derived biomarkers. Functional CT approaches can estimate hemodynamic significance and microvascular impairment, while myocardial and extracardiac findings support comprehensive differential diagnosis despite limitations.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/cardiac-ct-in-non-obstructive-coronary-artery-disease-nocad-a-literature-review/461522/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/cardiac-ct-in-non-obstructive-coronary-artery-disease-nocad-a-literature-review/461522.png","ImageObject",300,407,{"name":92,"@type":93},"Mafia Boss","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-07","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What conditions are included in non-obstructive coronary artery disease (NOCAD)?","Question",{"text":112,"@type":113},"NOCAD includes scenarios where patients present with angina, ischemia, or myocardial infarction without obstructive epicardial stenoses. The spectrum includes MINOCA and ANOCA/INOCA.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does cardiac CT contribute to NOCAD assessment?",{"text":117,"@type":113},"Cardiac CT provides anatomical, functional, and tissue-level assessment beyond excluding obstructive CAD. It can identify nonobstructive atherosclerosis, plaque features, myocardial bridging, and enables functional evaluation using CT-derived methods.",{"name":119,"@type":110,"acceptedAnswer":120},"What are the main limitations of cardiac CT in NOCAD?",{"text":121,"@type":113},"Cardiac CT is limited by spatial resolution and radiation exposure, and it cannot directly visualize the microcirculation. Routine use of some functional CT techniques is also constrained by methodological variability and evolving evidence.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},461522,1790945269,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},962090760730,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Review  \nCardiac CT in Non-Obstructive Coronary Artery Disease (NOCAD): A Literature Review  \nSofia Meossi, Carmen Izzo , Laura Rotondo , Giorgio Sciaramenti, Edoardo Menzato , Beatrice Dal Passo , Renè Tezze, Federica Frascaro , Elisabetta Tonet, Federico Marchini , Gianluca Campo  and Rita Pavasini *  \nAcademic Editor: Alistair Royse  \nReceived: 3 December 2025  \nRevised: 16 December 2025  \nAccepted: 17 December 2025  \nPublished: 20 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \nCardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy; [sofimeossi@gmail.com](sofimeossi@gmail.com) (S.M.);  \n[carmen.izzo2017@gmail.com](carmen.izzo2017@gmail.com) (C.I.); [laura.rotondo11@gmail.com](laura.rotondo11@gmail.com) (L.R.); [giorgio.sciaramenti@gmail.com](giorgio.sciaramenti@gmail.com) (G.S.);  \n[edoardo.menzato@gmail.com](edoardo.menzato@gmail.com) (E.M.); [beatrice.dalpasso@edu.unife.it](beatrice.dalpasso@edu.unife.it) (B.D.P.); [rene.tezze@gmail.com](rene.tezze@gmail.com) (R.T.);  \n[federica.frascaro92@gmail.com](federica.frascaro92@gmail.com) (F.F.); [mrcfrc2@unife.it](mrcfrc2@unife.it) (F.M.); [cmpglc@unife.it](cmpglc@unife.it) (G.C.)  \n* [Correspondence: pvsrti@unife.it](Correspondence: pvsrti@unife.it)  \nAbstract  \nNon-obstructive coronary artery disease (NOCAD) encompasses a heterogeneous group of conditions in which patients present with angina, ischemia or myocardial infarction despite the absence of obstructive epicardial stenoses. This spectrum includes myocardial infarction with non-obstructive coronary arteries (MINOCA) and angina or ischemia with non-obstructive coronary arteries (ANOCA/INOCA), entities increasingly recognized as clinically significant and associated with adverse outcomes. Advances in cardiac computed tomography (CT) have expanded the diagnostic capabilities beyond the exclusion of obstructive coronary artery disease, enabling comprehensive anatomical, functional and tissue-level assessment relevant to NOCAD. CT allows precise identification of nonobstructive atherosclerosis, high-risk plaque features, myocardial bridging and structural vascular remodelling. Quantitative and qualitative characterization of plaque burden correlates with ischemic risk and provides prognostic information that complements traditional stenosis-based evaluation. Emerging CT-derived biomarkers, such as pericoronary fat attenuation index and epicardial adipose tissue metrics, offer insight into vascular inflammation and microvascular dysfunction, key mechanisms in NOCAD. Functional CT techniques, such as CT-derived fractional flow reserve and CT perfusion imaging, enable non-invasive assessment of hemodynamic significance and microvascular impairment, although their routine use is limited by methodological variability and evolving clinical evidence. Beyond coronary evaluation, CT also provides myocardial tissue characterization, detects extracardiac causes of symptoms and contributes to comprehensive differential diagnosis. Despite its strengths, cardiac CT remains limited by spatial resolution, radiation exposure and its inability to directly visualize the microcirculation. Nevertheless, ongoing technological refinement and integration of computational modelling are likely to enhance its diagnostic and prognostic role.  \nKeywords: cardiac CT; non obstructive coronary artery disease; NOCAD; CAD  \n1. Introduction  \nAlthough obstructive atherosclerotic coronary artery disease (CAD) is the leading cause of ischemic heart disease in the general population, a substantial subset of individuals presenting with angina or acute coronary syndromes are found to have no obstructive coronary artery disease on angiography. Non-obstructive coronary artery disease (NOCAD)  \nrefers to a heterogeneous spectrum of clinical entities defined as anatom","cbCaikaxyMDmTgIu","https://ap.wps.com/l/cbCaikaxyMDmTgIu","pdf",2745935,15,"English","# Abstract\n# 1. Introduction\n# 2. Definitions\n## Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA)\n## Angina with Non-Obstructive Coronary Arteries (ANOCA) and Ischemia with Non-Obstructive Coronary Arteries (INOCA)","[{\"question\":\"What conditions are included in non-obstructive coronary artery disease (NOCAD)?\",\"answer\":\"NOCAD includes scenarios where patients present with angina, ischemia, or myocardial infarction without obstructive epicardial stenoses. The spectrum includes MINOCA and ANOCA/INOCA.\"},{\"question\":\"How does cardiac CT contribute to NOCAD assessment?\",\"answer\":\"Cardiac CT provides anatomical, functional, and tissue-level assessment beyond excluding obstructive CAD. It can identify nonobstructive atherosclerosis, plaque features, myocardial bridging, and enables functional evaluation using CT-derived methods.\"},{\"question\":\"What are the main limitations of cardiac CT in NOCAD?\",\"answer\":\"Cardiac CT is limited by spatial resolution and radiation exposure, and it cannot directly visualize the microcirculation. Routine use of some functional CT techniques is also constrained by methodological variability and evolving evidence.\"}]","Cardiac CT in Non-Obstructive Coronary Artery Disease (NOCAD) - A Literature Review | PDF",1790761789,38]