CT derived fractional flow reserve: Part 1 - Comprehensive review of methodologies.

Journal: Journal of cardiovascular computed tomography
Published Date: Jul 18, 2025

Abstract

Advancements in cardiac computed tomography angiography (CCTA) have enabled the extraction of physiological data from an anatomy-based imaging modality. This review outlines the key methodologies for deriving fractional flow reserve (FFR) from CCTA, with a focus on two primary methods: 1) computational fluid dynamics-based FFR (CT-FFR) and 2) plaque-derived ischemia assessment using artificial intelligence and quantitative plaque metrics. These techniques have expanded the role of CCTA beyond anatomical assessment, allowing for concurrent evaluation of coronary physiology without the need for invasive testing. This review provides an overview of the principles, workflows, and limitations of each technique and aims to inform on the current state and future direction of non-invasive coronary physiology assessment.

Authors

  • Kashif Shaikh
    University of Tennessee Medical Center, Knoxville (K.S.).
  • Patricia Rodriguez Lozano
    Department of Medicine, Cardiovascular Division, University of Virgina Health, Charlottesville, VA, USA; Department of Radiology and Medical Imaging University of Virginia Health, Charlottesville, VA, USA.
  • Sotirios Evangelou
    Department of Cardiology, European Interbalkan Medical Center, Thessaloniki, Greece.
  • En-Haw Wu
    Department of Diagnostic Radiology, Oregon Health and Science University, OR, USA.
  • Nick S Nurmohamed
    Division of Cardiology, The George Washington University School of Medicine, Washington, DC, USA.
  • Nidhi Madan
    UnityPoint Health St Luke's Hospital, Cedar Rapids, IA, USA.
  • Dhiran Verghese
    Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Los Angeles.
  • Chandana Shekar
    Portneuf Medical Center, Pocatello, ID, USA.
  • Anam Waheed
    Medstar Heart and Vascular Center, Washington Hospital Center, Georgetown University Hospital, Washington, DC, USA.
  • Saira Siddiqui
    Department of Pediatrics, Morristown Medical Center, Morristown, NJ, USA; Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
  • Márton Kolossváry
    Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. Electronic address: marton.kolossvary@cirg.hu.
  • Shone Almeida
    University of South Florida, Heart and Vascular Institute at Tampa General Hospital, Tampa, FL, USA.
  • Tyler Coombes
    Department of Medicine, Division of Cardiology, University of Tennessee, Knoxville, TN, USA.
  • Dominika Suchá
    Department of Radiology, University Medical Center Utrecht, Utrecht, 3584 CX, Netherlands.
  • Siddharth J Trivedi
    Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • Abdul Rahman Ihdayhid
    Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Melbourne, Victoria, Australia 3168 (A.R.I.); and Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (S.B.Z.).

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