Coronary CT angiography (CCTA) offers excellent negative predictive value for ruling out obstructive coronary artery disease (CAD); however, several interpretative pitfalls can lead to diagnostic errors including false-negative, false-positive results or inaccurate estimation of degree of stenosis. These errors may influence patient management, prompt unnecessary or missed downstream testing, and ultimately affect clinical outcomes. This two-part article reviews the most common sources of diagnostic inaccuracy in CCTA through case-based examples. Part I highlights factors that contribute to missed or overdiagnosed coronary lesions while Part II focuses on pitfalls that lead to underestimation or overestimation of stenosis severity and outlines practical strategies to mitigate these errors. Recognizing the inherent limitations of CCTA and employing a systematic, structured interpretive approach are essential for preserving its high diagnostic accuracy and ensuring optimal patient care.
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