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Coronary CT-Derived Fractional Flow Reserve

  • New Imaging Technologies (U J Schoepf, Section Editor)
  • Published:
Current Radiology Reports Aims and scope Submit manuscript

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.

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Recently published papers of particular interest have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA

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

  2. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany

    Moritz H. Albrecht

  3. Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza”, Latina, Italy

    Domenico De Santis

  4. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Heidelberg, Germany

    Thomas Henzler & Stefan O. Schoenberg

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  1. Philipp von Knebel Doeberitz
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  2. Moritz H. Albrecht
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  3. Carlo N. De Cecco
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  4. John W. Nance
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Correspondence to U. Joseph Schoepf.

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Conflict of interest

Philipp von Knebel Doeberitz, Moritz H. Albrecht, John W. Nance, Brian Jacobs, Marwen Eid, Domenico De Santis, Thomas Henzler, and Stefan O. Schoenberg each declare no potential conflicts of interest. Carlo N. De Cecco receives research support from Siemens. U. Joseph Schoepf is a consultant for and/or receives research support from Astellas, Bayer, GE, Guerbet, Medrad, and Siemens. Dr. Schoepf is a section editor for Current Radiology Reports.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on New Imaging Technologies.

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von Knebel Doeberitz, P., Albrecht, M.H., De Cecco, C.N. et al. Coronary CT-Derived Fractional Flow Reserve. Curr Radiol Rep 5, 40 (2017). https://doi.org/10.1007/s40134-017-0234-8

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  • DOI: https://doi.org/10.1007/s40134-017-0234-8

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