The additive value of FFR-CT in the evaluation of calcified coronary arteries with Coronary CT Angiography.

Coronary computed tomography angiography (CCTA) has evolved as one of the most frequently utilized modalities for the evaluation of chest pain and the diagnosis of obstructive coronary artery disease in an outpatient (stable chest pain) or emergency /inpatient setting (unstable chest pain). However, severe coronary artery calcification (CAC) is known to be one of the most significant limitations of the technique, leading to false positive findings, mostly secondary to blooming artifact. Fractional flow reserve derived from coronary CT angiography (FFR-CT) has demonstrated acceptable correlation and agreement with invasive FFR, and due to its higher specificity and negative predictive value, enhances CCTA's diagnostic performance. There are published reports showing that the diagnostic performance of FFR-CT is affected less by severe CAC compared with CCTA alone. In this review, we present the current evidence of how FFR-CT can increase the accuracy of CCTA for the evaluation of calcified coronary arteries.