Abstract
Coronary CT angiography provides increasingly excellent anatomic detail of coronary stenosis, with a high sensitivity and negative predictive value for coronary artery disease (CAD). From the advent of this technology, however, concerns were raised regarding the limited specificity of the technology for determining which coronary stenoses cause myocardial ischemia [1]. This determination is important, as detection of ischemia is the cornerstone of “functional” testing for CAD, whether noninvasively through myocardial perfusion imaging (MPI) and stress echocardiography or invasively through fractional flow reserve (FFR) [2]. There was also hesitation that the highly sensitive anatomic detection of CAD by CT could lead to increased invasive downstream testing and revascularization, which was observed in CT trials [3, 4]. Functional imaging providing information about specific lesions or the subtended myocardium could potentially improve the value of a CT scan and its role as a gatekeeper to the catheterization laboratory [5]. As such, a major focus of CT research has been the devising of techniques to garner functional information from CT images. Early success augurs future progress in this area.
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Suggested Reading
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Acknowledgement
We appreciate the provision of images from Dr. Christopher K. Zarins, HeartFlow, Inc.
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Schulman-Marcus, J., Min, J.K. (2018). Functional Significance of Coronary Stenoses Identified by CT. In: Budoff, M., Achenbach, S., Hecht, H., Narula, J. (eds) Atlas of Cardiovascular Computed Tomography. Springer, London. https://doi.org/10.1007/978-1-4471-7357-1_9
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