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CFR and FFR Assessment with PET and CTA: Strengths and Limitations

  • Nuclear Cardiology (V Dilsizian, Section Editor)
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Abstract

Positron emission tomography (PET) myocardial perfusion imaging (MPI) has high diagnostic accuracy and prognostic value. PET-MPI can also be used to quantitatively evaluate regional myocardial blood flow (MBF). This technique also allows the calculation of the coronary flow reserve (CFR)/myocardial flow reserve (MFR), which is the ratio of MBF at peak hyperemia to resting MBF. Coronary computed tomography angiography (CTA) is a non-invasive method for accurate detection and exclusion of high-grade coronary stenoses, when compared to an invasive coronary angiography reference standard. However, CTA assessment of coronary stenoses tends toward overestimation, and CTA cannot determine physiologic significance of lesions. Recent advances in computational fluid dynamics and image-based modeling permit calculation of non-invasive fractional flow reserve derived from CT (FFRCT), without the need for additional imaging, modification of acquisition protocols, or administration of medications. In this review, we cover the CFR/MFR assessment by PET and FFR assessment by CT.

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Abbreviations

CAD:

Coronary artery disease

CFD:

Computational fluid dynamics

CFR:

Coronary flow reserve

CTA:

Computed tomographic angiography

FFR:

Fractional flow reserve

FFRCT :

Fractional flow reserve derived from CT

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

NPV:

Negative predictive value

PET:

Positron emission tomography

PPV:

Positive predictive value

SPECT:

Single-photon emission computed tomography

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Acknowledgments

This study was funded by grants from the National Institutes of Health (R01HL11515002 and R01HL11801901). This study was also funded by a gift from the Dalio Institute of Cardiovasular Imaging and the Michael Wolk Foundation.

Compliance with Ethics Guidelines

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Conflict of Interest

Ryo Nakazato declares that he has no conflict of interest.

Ran Heo declares that he has no conflict of interest.

Jonathon Leipsic has received grant support from and been a consultant for HeartFlow. He has received payment for development of educational presentations including service on speakers' bureaus from GE Healthcare.

James K. Min has received grant support from HeartFlow. He serves as a consultant to HeartFlow.

Human and Animal Rights and Informed Consent

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

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Authors and Affiliations

  1. St. Luke’s International Hospital, Tokyo, Japan

    Ryo Nakazato

  2. Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, NY, USA

    Ran Heo & James K. Min

  3. St. Paul’s Hospital, Vancouver, British Columbia, Canada

    Jonathon Leipsic

  4. Departments of Radiology and Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, 520 E. 70th Street, New York, NY, 10021, USA

    James K. Min

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  1. Ryo Nakazato
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Correspondence to James K. Min.

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Nakazato, R., Heo, R., Leipsic, J. et al. CFR and FFR Assessment with PET and CTA: Strengths and Limitations. Curr Cardiol Rep 16, 484 (2014). https://doi.org/10.1007/s11886-014-0484-5

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