Patel Pratik, Emrich Tilman, Schoepf U Joseph, Mehta Varun, Bayer Richard R, von Assen Marly, Giovagnoli Vincent, Jeudy Jean, Varga-Szemes Akos, White Charles
Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD.
Department of Radiology, University of Florida College of Medicine, Gainesville, FL.
J Thorac Imaging. 2023 Jul 1;38(4):212-225. doi: 10.1097/RTI.0000000000000592. Epub 2021 May 24.
Coronary computed tomographic angiography (CCTA) has emerged as a fast and robust tool with high sensitivity and excellent negative predictive value for the evaluation of coronary artery disease, but is unable to estimate the hemodynamic significance of a lesion. Advances in computed tomography (CT)-based diagnostic techniques, for example, CT-derived fractional flow reserve and CT perfusion, have helped transform CCTA primarily from an anatomic assessment tool to a technique that is able to provide both anatomic and functional information for a stenosis. With the results of the ISCHEMIA trial published in 2019, these advanced techniques can elevate CCTA into the role of a better gatekeeper for decision-making and can help guide referral for invasive management. In this article, we review the principles, limitations, diagnostic performance, and clinical utility of these 2 functional CT-based techniques in the evaluation of vessel-specific and lesion-specific ischemia.
冠状动脉计算机断层血管造影（CCTA）已成为一种快速且可靠的工具，在评估冠状动脉疾病方面具有高敏感性和出色的阴性预测价值，但无法评估病变的血流动力学意义。基于计算机断层扫描（CT）的诊断技术的进展，例如CT衍生的血流储备分数和CT灌注，已帮助将CCTA主要从一种解剖评估工具转变为一种能够为狭窄提供解剖和功能信息的技术。随着2019年发表的ISCHEMIA试验结果，这些先进技术可将CCTA提升为更好的决策把关者，并有助于指导侵入性治疗的转诊。在本文中，我们回顾了这两种基于CT的功能技术在评估血管特异性和病变特异性缺血方面的原理、局限性、诊断性能和临床应用。
