CT derived fractional flow reserve: Part 1 – Comprehensive review of methodologies

Kashif Shaikh; Patricia Rodriguez Lozano; Sotirios Evangelou; En-Haw Wu; Nick S. Nurmohamed; Nidhi Madan; Dhiran Verghese; Chandana Shekar; Anam Waheed; Saira Siddiqui; M. rton Kolossváry; Shone Almeida; Tyler Coombes; Dominika Suchá; Siddharth J. Trivedi; the SCCT FiRST (Fellow and Resident Leaders of SCCT) Committee

doi:10.1016/j.jcct.2025.07.001

CT derived fractional flow reserve: Part 1 – Comprehensive review of methodologies

Kashif Shaikh
, Patricia Rodriguez Lozano
, Sotirios Evangelou
, En-Haw Wu
, Nick S. Nurmohamed
, Nidhi Madan
, Dhiran Verghese
, Chandana Shekar
, Anam Waheed
, Saira Siddiqui
, M. rton Kolossváry
, Shone Almeida
, Tyler Coombes
, Dominika Suchá
, Siddharth J. Trivedi
, the SCCT FiRST (Fellow and Resident Leaders of SCCT) Committee

University of Tennessee Health Science Center
University of Virginia
European Interbalkan Medical Center
Oregon Health and Science University
Vrije Universiteit Amsterdam
University of Amsterdam
George Washington University
UnityPoint Health
NCH
Portneuf Medical Center
Washington Hospital Center
Morristown Medical Center
Thomas Jefferson University
Gottsegen National Cardiovascular Center
Óbuda University
University of South Florida
Utrecht University
Harvard University
Fiona Stanley Hospital
Curtin University

Research output: Contribution to journal › Review article › Academic › peer-review

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Abstract

Advancements in cardiac computed tomography angiography (CCTA) have enabled the extraction of physiological data from an anatomy-based imaging modality. This review outlines the key methodologies for deriving fractional flow reserve (FFR) from CCTA, with a focus on two primary methods: 1) computational fluid dynamics-based FFR (CT-FFR) and 2) plaque-derived ischemia assessment using artificial intelligence and quantitative plaque metrics. These techniques have expanded the role of CCTA beyond anatomical assessment, allowing for concurrent evaluation of coronary physiology without the need for invasive testing. This review provides an overview of the principles, workflows, and limitations of each technique and aims to inform on the current state and future direction of non-invasive coronary physiology assessment.

Original language	English
Pages (from-to)	390-396
Number of pages	7
Journal	Journal of cardiovascular computed tomography
Volume	19
Issue number	4
Early online date	2025
DOIs	https://doi.org/10.1016/j.jcct.2025.07.001
Publication status	Published - 1 Jul 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Computational fractional flow reserve
Coronary artery disease
Coronary computed tomography angiography

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10.1016/j.jcct.2025.07.001

Ct-derived-fractional-flow-reserve.pdfFinal published version, 2.63 MBLicence: Taverne

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Shaikh, K., Lozano, P. R., Evangelou, S., Wu, E.-H., Nurmohamed, N. S., Madan, N., Verghese, D., Shekar, C., Waheed, A., Siddiqui, S., Kolossváry, M. R., Almeida, S., Coombes, T., Suchá, D., Trivedi, S. J., & the SCCT FiRST (Fellow and Resident Leaders of SCCT) Committee (2025). CT derived fractional flow reserve: Part 1 – Comprehensive review of methodologies. Journal of cardiovascular computed tomography, 19(4), 390-396. https://doi.org/10.1016/j.jcct.2025.07.001

@article{2ab87a0873174aa584b085b244c63b53,

title = "CT derived fractional flow reserve: Part 1 – Comprehensive review of methodologies",

abstract = "Advancements in cardiac computed tomography angiography (CCTA) have enabled the extraction of physiological data from an anatomy-based imaging modality. This review outlines the key methodologies for deriving fractional flow reserve (FFR) from CCTA, with a focus on two primary methods: 1) computational fluid dynamics-based FFR (CT-FFR) and 2) plaque-derived ischemia assessment using artificial intelligence and quantitative plaque metrics. These techniques have expanded the role of CCTA beyond anatomical assessment, allowing for concurrent evaluation of coronary physiology without the need for invasive testing. This review provides an overview of the principles, workflows, and limitations of each technique and aims to inform on the current state and future direction of non-invasive coronary physiology assessment.",

keywords = "Computational fractional flow reserve, Coronary artery disease, Coronary computed tomography angiography",

author = "Kashif Shaikh and Lozano, \{Patricia Rodriguez\} and Sotirios Evangelou and En-Haw Wu and Nurmohamed, \{Nick S.\} and Nidhi Madan and Dhiran Verghese and Chandana Shekar and Anam Waheed and Saira Siddiqui and Kolossv{\'a}ry, \{M. rton\} and Shone Almeida and Tyler Coombes and Dominika Such{\'a} and Trivedi, \{Siddharth J.\} and \{the SCCT FiRST (Fellow and Resident Leaders of SCCT) Committee\} and Ihdayhid, \{Abdul Rahman\}",

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year = "2025",

month = jul,

day = "1",

doi = "10.1016/j.jcct.2025.07.001",

language = "English",

volume = "19",

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Shaikh, K, Lozano, PR, Evangelou, S, Wu, E-H, Nurmohamed, NS, Madan, N, Verghese, D, Shekar, C, Waheed, A, Siddiqui, S, Kolossváry, MR, Almeida, S, Coombes, T, Suchá, D, Trivedi, SJ & the SCCT FiRST (Fellow and Resident Leaders of SCCT) Committee 2025, 'CT derived fractional flow reserve: Part 1 – Comprehensive review of methodologies', Journal of cardiovascular computed tomography, vol. 19, no. 4, pp. 390-396. https://doi.org/10.1016/j.jcct.2025.07.001

TY - JOUR

T1 - CT derived fractional flow reserve

T2 - Part 1 – Comprehensive review of methodologies

AU - Shaikh, Kashif

AU - Lozano, Patricia Rodriguez

AU - Evangelou, Sotirios

AU - Wu, En-Haw

AU - Nurmohamed, Nick S.

AU - Madan, Nidhi

AU - Verghese, Dhiran

AU - Shekar, Chandana

AU - Waheed, Anam

AU - Siddiqui, Saira

AU - Kolossváry, M. rton

AU - Almeida, Shone

AU - Coombes, Tyler

AU - Suchá, Dominika

AU - Trivedi, Siddharth J.

AU - the SCCT FiRST (Fellow and Resident Leaders of SCCT) Committee

AU - Ihdayhid, Abdul Rahman

PY - 2025/7/1

Y1 - 2025/7/1

N2 - Advancements in cardiac computed tomography angiography (CCTA) have enabled the extraction of physiological data from an anatomy-based imaging modality. This review outlines the key methodologies for deriving fractional flow reserve (FFR) from CCTA, with a focus on two primary methods: 1) computational fluid dynamics-based FFR (CT-FFR) and 2) plaque-derived ischemia assessment using artificial intelligence and quantitative plaque metrics. These techniques have expanded the role of CCTA beyond anatomical assessment, allowing for concurrent evaluation of coronary physiology without the need for invasive testing. This review provides an overview of the principles, workflows, and limitations of each technique and aims to inform on the current state and future direction of non-invasive coronary physiology assessment.

AB - Advancements in cardiac computed tomography angiography (CCTA) have enabled the extraction of physiological data from an anatomy-based imaging modality. This review outlines the key methodologies for deriving fractional flow reserve (FFR) from CCTA, with a focus on two primary methods: 1) computational fluid dynamics-based FFR (CT-FFR) and 2) plaque-derived ischemia assessment using artificial intelligence and quantitative plaque metrics. These techniques have expanded the role of CCTA beyond anatomical assessment, allowing for concurrent evaluation of coronary physiology without the need for invasive testing. This review provides an overview of the principles, workflows, and limitations of each technique and aims to inform on the current state and future direction of non-invasive coronary physiology assessment.

KW - Computational fractional flow reserve

KW - Coronary artery disease

KW - Coronary computed tomography angiography

UR - https://www.scopus.com/pages/publications/105010903014

U2 - 10.1016/j.jcct.2025.07.001

DO - 10.1016/j.jcct.2025.07.001

M3 - Review article

C2 - 40683785

SN - 1934-5925

VL - 19

SP - 390

EP - 396

JO - Journal of cardiovascular computed tomography

JF - Journal of cardiovascular computed tomography

IS - 4

ER -

CT derived fractional flow reserve: Part 1 – Comprehensive review of methodologies

Abstract

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Keywords

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