Noninvasive Physiologic Assessment of Coronary Stenoses Using Cardiac CT

Abstract

Coronary CT angiography (CCTA) has become an important noninvasive imaging modality in the diagnosis of coronary artery disease (CAD). CCTA enables accurate evaluation of coronary artery stenosis. However, CCTA provides limited information on the physiological significance of stenotic lesions. A noninvasive “one-stop-shop” diagnostic test that can provide both anatomical significance and functional significance of stenotic lesions would be beneficial in the diagnosis and management of CAD. Recently, with the introduction of novel techniques, such as myocardial CT perfusion, CT-derived fractional flow reserve (FFRCT), and transluminal attenuation gradient (TAG), CCTA has emerged as a noninvasive method for the assessment of both anatomy of coronary lesions and its physiological consequences during a single study. This review provides an overview of the current status of new CT techniques for the physiologic assessments of CAD.

Correlations Between the Gradient of Contrast Density, Evaluated by Cardio CT, and Functional Significance of Coronary Artery Stenosis

“…Intraluminal contrast density gradient determination using Coronary Computed Tomography Angiography provides new information useful for complex characterization of the stenotic lesions located in the coronary arteries [6,7]. We observed a significantly higher contrast density gradient in case of significant stenosis with luminal narrowing >70%, as compared with the stenosis with luminal narrowing <70%.…”

Anatomy and physiology in coronary artery disease imaging

“…TAG is able to improve sensitivity and specificity of CCT over stenosis degree assessment alone. 17 As for CO and CCO, it is a parameter that can be calculated even without sophisticated software and the assessment is implemented into the most advanced processing software available on the market. This is the first study to compare CCO with stress Myocardial Blood Flow (MBF) and to report on its ability to predict abnormal Relative Flow Reserve (RFR) 16 ; the study shows that the presence of an abnormal CCO decrease is associated with significantly lower RFR even though with moderate diagnostic accuracy; however, the absence of CCO decrease excludes an abnormal RFR with high negative predictive value.…”

Coronary Computed Tomography Angiography in Combination with Coronary Artery Calcium Scoring for the Preoperative Cardiac Evaluation of Liver Transplant Recipients

“…Noninvasive coronary imaging has been a topic of great research interest for a number of years [50]. CCTA is validated as a potential alternative to coronary angiography for diagnosing and grading the severity of CAD in a large number of patients [19, 51].…”