The Society of Cardiovascular Computed Tomography (SCCT) and the Society for Cardiovascular Angiography and Interventions (SCAI) have published an expert consensus document on the use of coronary CT angiography (CCTA)-derived fractional flow reserve (FFR-CT) for assessing coronary artery disease.
Published in the Journal of Cardiovascular Computed Tomography and endorsed by the American College of Cardiology (ACC), the document provides evidence-based guidance on the acquisition, interpretation, and reporting of FFR-CT. Key recommendations include the following:
- High-quality CCTA imaging is essential for accurate FFR-CT computation, with nitroglycerin and heart rate control improving diagnostic accuracy. Motion artifacts and calcification can affect FFR-CT reliability.
- FFR-CT has its greatest clinical utility in patients with stable chest pain and intermediate stenosis to guide revascularization decisions.
- FFR-CT values should be integrated into CCTA reports, with stenosis-specific values measured 2 cm distal to the lesion, which the writing group said has the most robust evidence base for clinical outcomes and longer-term prognosis.
The consensus document covers acquisition, diagnostic accuracy, clinical applications including stable chest pain, multivessel disease, and acute chest pain, as well as prognostic value and future directions.
![Axial images from unenhanced calcium score cardiac CT (left) and curved planar reformation images from CT angiography (right) show that higher long-term exposure to air pollution is associated with greater coronary artery calcium and more obstructive coronary artery disease (CAD). Top row: Images in a 68-year-old male patient with higher 10-year mean ambient air pollution exposure (7.9 μg/m3 for particulate matter measuring ≤2.5 μm in diameter [PM2.5] and 17.4 parts per billion [ppb] for NO2) with extensive CAD (coronary artery calcium score [CACS] >1,000 and obstructive CAD [≥70% diameter stenosis]). Bottom row: Images in a 57-year-old female patient with lower 10-year mean ambient air pollution exposure (6.3 μg/m3 for PM2.5 and 4.6 ppb for NO2) with no CAD (CACS = 0 and no obstructive stenosis).](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/06/hanneman.r6SMLzkezo.png?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
