Physiologic evaluation of ischemia using cardiac CT: current status of CT myocardial perfusion and CT fractional flow reserve. [Review]
Physiologic evaluation of ischemia using cardiac CT: current status of CT myocardial perfusion and CT fractional flow reserve. [Review]
- 2014
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. Copyright Published by Elsevier Inc.
English
1876-861X
*Coronary Angiography/mt [Methods]
*Fractional Flow Reserve, Myocardial
*Myocardial Ischemia/ra [Radiography]
*Myocardial Perfusion Imaging/mt [Methods]
*Tomography, X-Ray Computed
Humans
Myocardial Ischemia/pp [Physiopathology]
Predictive Value of Tests
Prognosis
MedStar Heart & Vascular Institute
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. Copyright Published by Elsevier Inc.
English
1876-861X
*Coronary Angiography/mt [Methods]
*Fractional Flow Reserve, Myocardial
*Myocardial Ischemia/ra [Radiography]
*Myocardial Perfusion Imaging/mt [Methods]
*Tomography, X-Ray Computed
Humans
Myocardial Ischemia/pp [Physiopathology]
Predictive Value of Tests
Prognosis
MedStar Heart & Vascular Institute