title: Physiologic evaluation of ischemia using cardiac CT: current status of CT myocardial perfusion and CT fractional flow reserve.
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.
authors.affiliation: Cardiology Division, MedStar Heart Institute, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington DC 20010, USA; Cardiology Division, Medstar Georgetown University Hospital, Washington, DC, USA; Cardiovascular and Pulmonary Branch, Advanced Cardiovascular Imaging Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA. Electronic address: Andrew.D.Choi@gunet.georgetown.edu.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Choi
authors.affiliation: Cardiology Division, MedStar Heart Institute, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington DC 20010, USA; Cardiology Division, Medstar Georgetown University Hospital, Washington, DC, USA.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Joly
authors.affiliation: Cardiovascular and Pulmonary Branch, Advanced Cardiovascular Imaging Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Marcus Y
authors.initials: MY
authors.lastname: Chen
authors.affiliation: Cardiology Division, MedStar Heart Institute, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington DC 20010, USA.
authors.forename: Wm Guy
authors.initials: WG
authors.lastname: Weigold
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D014057:Tomography, X-Ray Computed
keywords: Cardiac computed tomography; Computed tomography perfusion; Coronary artery disease; Fractional flow reserve; Ischemia