Physiologic evaluation of ischemia using cardiac CT: Current status of CT myocardial perfusion and CT fractional flow reserve |
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| Institution: | 1. Cardiology Division, MedStar Heart Institute, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington DC 20010, USA;2. Cardiology Division, Medstar Georgetown University Hospital, Washington, DC, USA;3. Cardiovascular and Pulmonary Branch, Advanced Cardiovascular Imaging Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA;1. Unidad de Cardiología Intervencionista, Hospital Universitario 12 de Octubre, Madrid, Spain;2. Departamento de Cardiología, Hospital de Galdácano, Galdácano, Vizcaya, Spain;3. Departamento de Cardiología, Hospital Vall d’Hebron, Barcelona, Spain;4. Departamento de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain;1. Faculty of Health Sciences, University of Macau, Macau, China;2. Department of Neurosurgery, Affiliated Hospital of Southwest Medical University, Sichuan Sheng, China;3. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;4. Beijing Neurosurgical Institute, Beijing, China;1. Department of Cardiology, Aarhus University Hospital, Brendstrupgaardsvej 100, Skejby, 8200 Aarhus N, Denmark;2. Harrington Heart and Vascular Institute, Case Medical Center, Cleveland, OH, USA;3. Department of Cardiology, Golden Jubilee National Hospital, Glasgow, Scotland;4. Department of Radiology, St. Paul''s Hospital, Vancouver, BC, Canada;5. Department of Cardiology, University of Erlangen, Erlangen, Germany |
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| Abstract: | Cardiac CT, specifically coronary CT angiography (CTA), is an established technology which detects anatomically significant coronary artery disease with a high sensitivity and negative predictive value compared with invasive coronary angiography. However, the limited ability of CTA to determine the physiologic significance of intermediate coronary stenoses remains a shortcoming compared with other noninvasive methods such as single-photon emission CT, stress echocardiography, and stress cardiac magnetic resonance. Two methods have been investigated recently: (1) myocardial CT perfusion and (2) fractional flow reserve (FFR) computed from CT (FFRCT). Improving diagnostic accuracy by combining the anatomic aspects of coronary CTA with a physiologic assessment via CT perfusion or FFRCT may reduce the need for additional testing to evaluate for ischemia, reduce downstream costs and risks associated with an invasive procedure, and lead to improved patient outcomes. Given a rapidly expanding body of research in this field, this comparative review summarizes the present literature while contrasting the benefits, limitations, and future directions in myocardial CT perfusion and FFRCT imaging. |
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| Keywords: | Cardiac computed tomography Computed tomography perfusion Coronary artery disease Fractional flow reserve Ischemia |
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