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

Shaikh, Kashif and Lozano, Patricia Rodriguez and Evangelou, Sotirios and Wu, En-Haw and Nurmohamed, Nick S. and Madan, Nidhi and Verghese, Dhiran and Shekar, Chandana and Waheed, Anam and Siddiqui, Saira and Kolossváry, Márton and Almeida, Shone and Coombes, Tyler and Suchá, Dominika and Trivedi, Siddharth J. and Ihdayhid, Abdul Rahman (2025) CT derived fractional flow reserve: Part 1 : Comprehensive review of methodologies. JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, 19 (4). pp. 390-396. ISSN 19345925

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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.

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