CT-FFR: How a new technology could transform cardiovascular diagnostic imaging

Abstract

Background

CT-based fractional flow reserve (CT-FFR) is a promising noninvasive method for the functional assessment of coronary stenosis. It expands the diagnostic capabilities of coronary CT angiography (cCTA) by providing hemodynamic information and potentially reducing unnecessary invasive coronary angiography examinations

Methods

This review summarizes current technological developments, study results, and clinical applications of CT-FFR. It also discusses the advantages and disadvantages of various software solutions, including artificial intelligence (AI)-based on-site analyses, and their potential integration into the clinical routine.

Results

Studies show that CT-FFR improves diagnostic accuracy compared to cCTA and can optimize patient management. Advances in artificial intelligence and new imaging techniques such as photon-counting CT could further refine CT-FFR and expand its applicability. Despite promising results, further research is needed regarding long-term validation, standardized workflows, and economic feasibility.

Conclusion

CT-FFR is a promising complementary tool for assessing the hemodynamic relevance of coronary stenoses. CT-FFR is particularly helpful in complex, long-segment, or consecutive stenosis, because a purely anatomical visual examination is not always sufficient. The combination of technical innovations and AI-assisted image analysis could have the potential to transform noninvasive coronary diagnostics.

Key Points

• CT-FFR increases specificity and diagnostic accuracy compared to cCTA alone.

• Technological advances could further refine CT-FFR and expand its applicability.

• The increasing adoption and improved applicability of CT-FFR in routine clinical practice is promising.

Citation Format

• Kloth C, Brendel JM, Kübler J et al. CT-FFR: How a new technology could transform cardiovascular diagnostic imaging. Rofo 2025; DOI 10.1055/a-2697-5413

Keywords

heart - CT-angiography - cardiac

Publication History

Received: 13 April 2025

Accepted after revision: 21 August 2025

Article published online:
15 October 2025

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