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CT-based myocardial ischemia evaluation: quantitative angiography, transluminal attenuation gradient, myocardial perfusion, and CT-derived fractional flow reserve

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Abstract

The detection of hemodynamically significant stenosis is important because ischemia-guided revascularization improves overall patient outcomes. Fractional flow reserve (FFR), which is measured during invasive coronary angiography, is regarded as the gold standard for determining hemodynamically significant coronary stenosis. Although coronary computed tomography angiography (CCTA) has been widely used to exclude significant coronary artery disease in patients with low to intermediate pretest probability, anatomic assessment by CCTA using diameter stenosis ≥50 % does not correlate well with the functional assessment of FFR. To overcome the weaknesses of conventional CCTA, such as its low specificity and positive predictive value, especially in patients with a small-diameter artery, poor image quality, or high calcium score, more sophisticated CCTA analysis methods have been developed to detect hemodynamically significant coronary stenosis. Studies that use the quantification of coronary plaque, transluminal attenuation gradient (TAG), CT myocardial perfusion (CTP), and CT-derived FFR have been conducted to validate their diagnostic performances, though each method has its pros and cons. This review provides details on the quantification of coronary plaque, TAG, CTP, and CT-derived FFR, including a definition of each, how to gather and interpret data, and the strengths and limitations of each. Further, we provide an overview of recent clinical studies.

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Abbreviations

CAD:

Coronary artery disease

CAG:

Coronary angiography

CCTA:

Coronary computed tomography angiography

CT:

Computed tomography

CTP:

Computed tomography perfusion

CT-derived FFR:

Computed tomography-derived fractional flow reserve

DS:

Diameter stenosis

FFR:

Fractional flow reserve

HU:

Hounsfield unit

IVUS:

Intravascular ultrasound

MLA:

Minimal lumen area

MLD:

Minimal lumen diameter

SPECT:

Single-photon emission computed tomography

TAG:

Transluminal attenuation gradient

%AS:

Percent area stenosis

%DS:

Percent diameter stenosis

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Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2013R1A1A1058711) and a grant of the Korean Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI12C0630).

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul, 138-736, South Korea

    Hyun Jung Koo, Dong Hyun Yang, Joon-Won Kang & Tae-Hwan Lim

  2. Department of Cardiology and Heart Institute, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Young-Hak Kim, Soo-Jin Kang & Jihoon Kweon

  3. Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea

    Hyun Jung Kim

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  7. Hyun Jung Kim
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  8. Tae-Hwan Lim
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Correspondence to Dong Hyun Yang.

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Koo, H.J., Yang, D.H., Kim, YH. et al. CT-based myocardial ischemia evaluation: quantitative angiography, transluminal attenuation gradient, myocardial perfusion, and CT-derived fractional flow reserve. Int J Cardiovasc Imaging 32 (Suppl 1), 1–19 (2016). https://doi.org/10.1007/s10554-015-0825-5

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