Advances in imaging technology have driven the rapid expansion in the use of computed tomography in the assessment of coronary atherosclerotic plaque. Current guidelines recommend coronary CT angiography as the first line diagnostic test for patients presenting with stable chest pain based on a rapidly growing evidence base. There is a growing need to refine current methods for diagnosis and risk stratification to better individualise preventative therapies. Imaging assessments of high-risk plaque with computed tomography can be used to differentiate stable from unstable patterns of coronary atherosclerosis and potentially to improve patient risk stratification. This review will focus on coronary imaging with computed tomography with a specific focus on the detection of coronary atherosclerosis, high-risk plaque features, and the implications for patient management.