During the last few decades, modern cardiac CT has shown a tremendous technical advancement which has led to a significant improvement of temporal as well as spatial resolution. However, despite these efforts, the focus on “morphology-only” remains one of the major drawbacks of cardiac CT when compared to invasive coronary angiography (CA). This is of special relevance since ischemia-dependent malperfusion of myocardial tissue – whether visualized by means of cardiac magnetic resonance (CMR), scintigraphy, PET or PET/CT – is an established indication for coronary revascularization, and the invasively measured fractional flow reserve (FFR) has been promoted as the real gold standard for treatment decision-making in CA . The ongoing, at times simplistic, debate about the importance of coronary anatomy versus coronary function has hampered the acceptance of cardiac CT for routine management of coronary artery disease (CAD) in clinical practice . Recent developments, however, have now made it possible to obtain even functional information by way of non-invasive cardiac CT.Two different approaches and techniques, namely CT myocardial perfusion (with/without pharmacological stress) and CT-derived FFR, have been introduced in cardiac CT to add functional biomarkers to its highly detailed morphological information.
Christian Loewe, Vienna (Austria)