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Noninvasive hemodynamic assessment using coronary computed tomography angiography: the present and future

J-B Park & B-K Koo

The paradigm has been shifted from anatomy-guided to physiology-guided management of coronary artery disease. Hence, intense attention has been focused on whether hemodynamic assessment can be achieved by noninvasive imaging modalities. Among them, coronary computed tomography (CT) has potentials to allow the assessment of ischemia-causing coronary stenosis due to its excellent spatial resolution. Currently, myocardial perfusion imaging, CT-derived computed fractional flow reserve and transluminal attenuation gradient are promising CT-based techniques to detect myocardial ischemia. Furthermore, its application can be extended beyond the detection of ischemia and to the measurement of hemodynamic forces acting on the plaque and the simulation of treatment plans using virtual stenting technique.