title: CT-based myocardial ischemia evaluation: quantitative angiography, transluminal attenuation gradient, myocardial perfusion, and CT-derived fractional flow reserve.
abstract: The detection of hemodynamically significant stenosis is important because ischemia-guided revascularization improves overall patient outcomes. Fractional flow reserve (FFR), which is measured during invasive coronary angiography, is regarded as the gold standard for determining hemodynamically significant coronary stenosis. Although coronary computed tomography angiography (CCTA) has been widely used to exclude significant coronary artery disease in patients with low to intermediate pretest probability, anatomic assessment by CCTA using diameter stenosis ≥50 % does not correlate well with the functional assessment of FFR. To overcome the weaknesses of conventional CCTA, such as its low specificity and positive predictive value, especially in patients with a small-diameter artery, poor image quality, or high calcium score, more sophisticated CCTA analysis methods have been developed to detect hemodynamically significant coronary stenosis. Studies that use the quantification of coronary plaque, transluminal attenuation gradient (TAG), CT myocardial perfusion (CTP), and CT-derived FFR have been conducted to validate their diagnostic performances, though each method has its pros and cons. This review provides details on the quantification of coronary plaque, TAG, CTP, and CT-derived FFR, including a definition of each, how to gather and interpret data, and the strengths and limitations of each. Further, we provide an overview of recent clinical studies.
authors.affiliation: Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, 138-736, South Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Koo
authors.affiliation: Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, 138-736, South Korea. donghyun.yang@gmail.com.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Yang
authors.affiliation: Department of Cardiology and Heart Institute, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, 138-736, South Korea.
authors.forename: Joon-Won
authors.initials: JW
authors.lastname: Kang
authors.affiliation: Department of Cardiology and Heart Institute, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Department of Cardiology and Heart Institute, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Jihoon
authors.initials: J
authors.lastname: Kweon
authors.affiliation: Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, 138-736, South Korea.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D012720:Severity of Illness Index
keywords: Computed tomography; Fractional flow reserve; Myocardial ischemia; Myocardial perfusion