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

Kashif Shaikh, Department of Medicine, Division of Cardiology, University of Tennessee, Knoxville, TN, USA.
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, Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; 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, Department of Medicine, NCH, FL, USA.
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, Gottsegen National Cardiovascular Center, Budapest, Hungary; Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary.
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 and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the 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, Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Curtin Medical School, Curtin University, Perth, WA, Australia. Electronic address: abdul.ihdayhid@perkins.org.au.

Document Type

Journal Article

Publication Date

7-18-2025

Journal

Journal of cardiovascular computed tomography

DOI

10.1016/j.jcct.2025.07.001

Keywords

Computational fractional flow reserve; Coronary artery disease; Coronary computed tomography angiography

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.

Department

Medicine

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