Dynamic Fractional Flow Reserve from 4D-CTA: A Novel Framework for Non-Invasive Coronary Assessment

Current fractional flow reserve computed tomography (FFR_CT) methods use static imaging, potentially missing critical hemodynamic changes during the cardiac cycle. We developed a novel dynamic FFR_CT framework using 4D-CTA data to capture temporal coronary dynamics throughout the complete cardiac cycle. Our automated pipeline integrates 4D-CTA processing, temporally weighted geometric modeling, and patient-specific boundary conditions derived from actual flow measurements. Preliminary validation in three patients (four vessels) showed that dynamic FFRCT values (0.720, 0.797, 0.811, and 0.952) closely matched invasive FFR measurements (0.70, 0.78, 0.78, and 0.94) with improved accuracy compared to conventional static methods. The dynamic approach successfully captured physiologically relevant hemodynamic variations, addressing inter-patient variability limitations of standardized approaches. This study establishes the clinical feasibility of dynamic FFR_CT computation, potentially improving non-invasive coronary stenosis assessment for clinical decision-making and treatment planning.