Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

Area of Science:

• Cardiology
• Medical Imaging
• Radiology

Background:

• Coronary computed tomography angiography (CTA) is a leading non-invasive tool for detecting coronary artery disease (CAD).
• CTA's limitations include modest specificity and positive predictive value in assessing the hemodynamic significance of coronary stenosis.
• Emerging CT techniques aim to overcome these limitations by evaluating myocardial ischemia.

Purpose of the Study:

• To review the current state and future directions of advanced CT imaging techniques for the physiological assessment of CAD.
• To highlight the integration of anatomical and functional evaluations in a single examination.

Main Methods:

• Review of CT-derived fractional flow reserve (FFR-CT), transluminal attenuation gradient (TAG), and CT perfusion (CTP) imaging.
• Discussion of CTP acquisition methods: single static scans (monoenergetic or dual-energy) and dynamic, time-resolved stress imaging with vasodilators.
• Exploration of qualitative, semi-quantitative, and quantitative perfusion assessment techniques.

Main Results:

• CTP imaging, FFR-CT, and TAG are emerging modalities for assessing myocardial ischemia.
• These techniques can be performed using various CT acquisition protocols, including stress perfusion imaging.
• The combination of anatomical and functional data from these CT methods aids clinical decision-making.

Conclusions:

• Advanced CT techniques are increasingly used in clinical practice for the physiological assessment of CAD.
• These methods offer the advantage of combining anatomical and functional information in a single imaging study.
• Future trends point towards broader adoption and refinement of these evolving imaging modalities in cardiology.