title: The value of noninvasive computed tomography derived fractional flow reserve in our current approach to the evaluation of coronary artery stenosis.
abstract: Contemporary diagnosis and management of stable chest pain symptoms possibly due to coronary ischemia is a frequent clinical challenge that involves a variety of test options, based upon either coronary angiographic (anatomic) or functional imaging. This review will discuss the evolution of coronary computed tomography derived fractional flow reserve (FFRCT) from basic science to a currently clinically approved diagnostic test.
  
  
  
  In recent years, FFR measured invasively in the coronary catheterization lab has demonstrated clinical outcome benefit for coronary revascularization decisions. Both coronary angiographic (anatomic) and functional myocardial imaging have been limited by an inability to reliably estimate physiologic significance determined by FFR. However, advances in computational fluid dynamics have led to interest in FFR estimated by coronary angiograms obtained noninvasively through coronary CT angiography.
  
  
  
  The current use of FFRCT has been mostly limited to research applications due to lack of availability and cost, as well as limited outcomes and cost-effectiveness data. Nevertheless, interest remains in the potential role of FFRCT for coronary revascularization treatment decisions, and thus, ongoing and future studies will continue to investigate this technology.
authors.affiliation: aCardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts bCardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, Maryland, United States.
authors.forename: Edward
authors.initials: E
authors.lastname: Hulten
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed / Q000379:methods*