Coronary CT-Derived Fractional Flow Reserve

Philipp von Knebel Doeberitz, Moritz H. Albrecht, Carlo N. De Cecco, John Nance, Brian Jacobs, Marwen Eid, Domenico De Santis, Thomas Henzler, Stefan O. Schoenberg, U. Joseph Schoepf

Research output: Contribution to journalArticle

Abstract

Purpose of Review: Coronary artery disease (CAD) is the leading cause of mortality in the United States and is accountable for a significant portion of overall healthcare costs. Non-invasive imaging plays a major role in the modern workup of CAD. This article will educate the reader on the foundations of computed tomography-derived fractional flow reserve (CT-FFR) and provide guidance for its appropriate clinical use. Recent Findings: Coronary computed tomography angiography (CCTA) has high sensitivity and negative predictive value to non-invasively rule out CAD. However, discrimination of ischemia-inducing lesions based on macroscopic anatomy derived from either CCTA or the gold standard for the detection of anatomic stenoses, invasive coronary angiography, is suboptimal. Invasive pressure wire-guided estimation of FFR across coronary stenoses yields reliable functional information regarding the effect of a lesion on myocardial blood supply. Recently, non-invasive methods have attempted to calculate FFR from CCTA datasets. CT-FFR allows for higher specificity compared to CCTA alone, while preserving the high sensitivity and negative predictive value of CCTA. Whereas off-site solutions for CT-FFR calculation have been heavily validated and are clinically available, other techniques that can be performed on-site have recently evolved and are under current investigation. Summary: Non-invasive CT-FFR has facilitated the reliable assessment of the hemodynamic significance of coronary artery stenosis, potentially increasing the specificity of the modality while maintaining its excellent sensitivity.

Original languageEnglish (US)
Article number40
JournalCurrent Radiology Reports
Volume5
Issue number9
DOIs
StatePublished - Sep 1 2017

Keywords

  • Coronary artery disease
  • Coronary artery stenosis
  • Coronary computed tomography angiography
  • Imaging
  • Non-invasive CT-FFR

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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