Novel techniques using computed tomography to assess the functional significance of coronary artery disease

Over the past 6 years, an important focus of CT research is the development of novel techniques to concomitantly evaluate the anatomical and functional significance of coronary artery disease which may broaden the future use of CT to assess both coronary anatomy and ischemia in a single examination. These techniques include 1) the prediction of a non-invasive fractional flow reserve (FFRCT) upon applying computational fluid dynamics on CTA images, 2) the assessment of the transluminal attenuation gradient (TAG) across coronary lesions and 3) the use of CT myocardial perfusion imaging (CTP) acquired during vasodilator stress. The aim of the thesis was first to review the novel CT techniques which have been recently evaluated to assess for coronary ischemia (chapter 1), to compare the diagnostic performance of transluminal attenuation gradient, using invasive fractional flow reserve as reference standard, with CT stress myocardial perfusion imaging (chapter 2), and non invasive fractional flow reserve derived from CT (chapter 3), to evaluate the feasibility and diagnostic performance of transluminal attenuation gradient acquired during vasodilator stress (chapter 4) and to finally assess the diagnostic accuracy of a score based on measures of area stenosis, lesion length and myocardium subtended quantified from CT coronary angiography (chapter 5).