Computational Fluid Dynamics Applied to Cardiac CT for Noninvasive Quantification of Fractional Flow Reserve: Scientific Basis

Coronary computed tomographic angiography (CT) has emerged as a non-invasive method for direct visualization of coronary artery disease (CAD), with prior studies demonstrating high diagnostic performance of CT compared to an invasive coronary angiography (ICA). However, CT assessment of coronary stenoses tends towards overestimation and even amongst CT-identified severe stenosis confirmed at the time of ICA, only a minority are found to be ischemia-causing. Recent advances in computational fluid dynamics and image-based modeling now permit determination of rest and hyperemic coronary flow and pressure from CT scans-without the need for additional imaging, modification of acquisition protocols, or administration of medications. These techniques have been used to non-invasively compute fractional flow reserve (FFR)- or the ratio of maximal coronary blood flow through a stenotic artery to the blood flow in the hypothetical case that the artery was normal-from CT images. In the recently reported prospective multicenter DISCOVER-FLOW and DeFACTO studies, FFR derived from CT, or FFRCT, was demonstrated as superior to measures of CT stenosis severity for determination of lesion-specific ischemia. Given the significant interest in this novel method for determining the physiologic significance of CAD, we herein present a review on the scientific principles that underlie this technology. 

PMID: 23562923

Posted in Computed Tomography, Invasive Imaging and tagged , , , , , , , .

One Comment

  1. Check also:

    Diagnostic accuracy of fractional flow reserve from anatomic CT angiography.
    Min JK, Leipsic J, Pencina MJ, Berman DS, Koo BK, van Mieghem C, Erglis A, Lin FY, Dunning AM, Apruzzese P, Budoff MJ, Cole JH, Jaffer FA, Leon MB, Malpeso J, Mancini GB, Park SJ, Schwartz RS, Shaw LJ, Mauri L.
    JAMA. 2012 Sep 26;308(12):1237-45.

    The authors point out that the use of noninvasive FFR-CT plus CT among stable patients with suspected or known CAD was associated with improved diagnostic accuracy and discrimination vs. CT alone for the diagnosis of hemodynamically significant CAD when FFR determined at the time of ICA was the reference standard.
    However, the authors acknowledge that the study did not achieve its pre-specified primary outcome goal for the level of per-patient diagnostic accuracy.

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