Diagnostic role of computed tomography (CT) and fractional flow reserve derived from CT in coronary artery disease

The increased number of patients with coronary artery disease is of great clinical relevance and carries a heavy burden on the health system. The management of these patients is focused on relieving symptoms and improving clinical outcomes. Therefore, the ideal test should provide the correct diagnosis and appropriate information for the best patient management. There is a growing need for non-invasive techniques that evaluate both the coronary anatomy and functional significance of a stenosis. Coronary computed tomography (CT) angiography has emerged as a unique non-invasive technique to exclude coronary artery stenoses and identify non-obstructive coronary artery disease. In recent years, coronary CT has emerged as a technique that is able to study both anatomy and functional significance of a stenosis by assessing myocardial perfusion after pharmacological stress or with fractional flow reserve measured by CT (FFR-CT). This paper will describe in deep the use of FFR-CT. Compared to other imaging techniques, both FFR-CT and stress myocardial CT perfusion allow the combination of the anatomical evaluation of coronary arteries and the functional relevance of coronary artery lesions, having the potential to revolutionize the diagnostic paradigm of suspected coronary artery disease.