Practical Clinical Application of Cardiac Computed Tomography– Derived Fractional Flow Reserve

In the past decade,advances in coronary computed tomography angiography(CTA)technology have resulted in high sensitivity and negative predictive value in detecting coronary artery disease(CAD)compared with invasive coronary angiography,particularly for patients with mild or severe stenosis.However,anatomical evaluation of CAD by CTA has modest specifi city for patients with intermediate-grade stenoses.The recent development of the use of cardiac computed tomography– derived fractional fl ow reserve(FFR-CT)seeks to address this gap as a proposed method of functional assessment of CAD by CTA.In this article we aim to mix common clinical cases with the current technical methods,validation,outcomes,and registry studies as well as the technical,fi nancial and research limitations of FFRCT analysis to guide the cardiac imaging specialist in evaluating this technique.FFR-CT analysis may help reduce additive functional testing for the smaller proportion of patients with intermediate stenosis undergoing coronary CTA where the atherosclerosis signifi cance is uncertain.