Computed tomography angiography-derived fractional flow reserve (CT-FFR) for the detection of myocardial ischemia with invasive fractional flow reserve as reference: systematic review and meta-analysis

  • Baiyan Zhuang
  • Shuli Wang
  • Shihua ZhaoEmail author
  • Minjie LuEmail author



A method named computed tomography angiography-derived fractional flow reserve (FFRCT) is an alternative method for detecting hemodynamically significant coronary stenosis. We carried out a meta-analysis to derive reliable assessment of the diagnostic performances of FFRCT and compare the diagnostic accuracy with CCTA using FFR as reference.


We searched PubMed, EMBASE, The Cochrane Library, and Web of science for relevant articles published from January 2008 until May 2019 using the following search terms: FFRCT, noninvasive FFR, non-invasive FFR, noninvasive fractional flow reserve, non-invasive fractional flow reserve, and CCTA. Pooled estimates of sensitivity and specificity with the corresponding 95% confidence intervals (CIs) and the summary receiver operating characteristic curve (sROC) were determined.


Sixteen studies published between 2011 and 2019 were included with a total of 1852 patients and 2731 vessels. The pooled sensitivity and specificity for FFRCT at the per-patient level was 89% (95% CI, 85–92%) and 71% (95% CI, 61–80%), respectively, while on the per-vessel basis was 85% (95% CI, 82–88%) and 82% (95% CI, 75–87%), respectively. No apparent difference in the sensitivity at per-patient and per-vessel level between FFRCT and CCTA was observed (0.89 versus 0.93 at per-patient; 0.85 versus 0.88 at per-vessel). However, the specificity of FFRCT was higher than CCTA (0.71 versus 0.32 at per-patient analysis; 0.82 versus 0.46 at per-vessel analysis).


FFRCT obtained a high diagnostic performance and is a viable alternative to FFR for detecting coronary ischemic lesions.

Key Points

Noninvasive FFRCThas higher specificity for anatomical and physiological assessment of coronary artery stenosis compared with CCTA.

Noninvasive FFRCTis a viable alternative to invasive FFR for the detection and exclusion of coronary lesions that cause ischemia.


Hemodynamics Computed tomography angiography Myocardial ischemia Stenosis Coronary artery disease 



Area under the SROC


Coronary artery disease


Coronary computed tomography angiography


Confidence intervals


Cardiovascular magnetic resonance


Computed tomography perfusion


Fractional flow reserve


Computed tomography angiography-derived fractional flow reserve


False negative


False positive


Inconsistency index


Invasive coronary angiography


Negative likelihood ratio


Positive likelihood ratio


Negative predictive value


Positive predictive value


Single-photon emission computed tomography


Summary receiver operating characteristic curve


True negative


True positive


Funding information

This study has received funding by Research Grant of National Natural Science Foundation of China (81571647, 81971588, 81620108015, 81771811), and Capital Clinical Special Program (Z191100006619021).

Compliance with ethical standards


The scientific guarantor of this publication is Minjie Lu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• multicenter study

Supplementary material

330_2019_6470_MOESM1_ESM.docx (1.7 mb)
ESM 1 (DOCX 1747 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

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