Send to

Choose Destination
See comment in PubMed Commons below
J Cardiovasc Comput Tomogr. 2012 May-Jun;6(3):191-9. doi: 10.1016/j.jcct.2012.04.010. Epub 2012 Apr 27.

Effect of image quality on diagnostic accuracy of noninvasive fractional flow reserve: results from the prospective multicenter international DISCOVER-FLOW study.

Author information

Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.



Fractional flow reserve calculated from coronary CT (FFR(CT)) is a novel method for determining lesion-specific ischemia.


To assess the effect of CT quality on accuracy of FFR(CT), we compared performance of FFR(CT) with severe stenosis by CT in relation to image quality; heart rate; signal-to-noise ratio (SNR); and common CT artifacts, including calcification, motion, and poor contrast enhancement.


FFR(CT) was performed on 159 vessels in 103 patients undergoing CT, FFR(CT), and FFR. Ischemia was defined as FFR(CT) and FFR ≤ 0.80, and severe stenosis by CT was defined by ≥50% reduction in luminal diameter. FFR(CT) and CT stenosis were compared with FFR, which served as the reference.


On a vessel basis, accuracy of FFR(CT) was higher than CT stenosis for satisfactory or poor quality CTs (87.5% vs 64.6%), for heart rates > 65 beats/min (100% vs 52.9%), and for SNR less than the median (26.3) (84.4% vs 64.1%). Accuracy of FFR(CT) was superior to CT stenosis in the presence of calcification (85.7% vs 66.7%), motion (90.5% vs 57.1%), and poor contrast opacification (100.0% vs 71.4%). Similar relations were observed for exploratory analyses of FFR(CT) and CT stenosis on a patient basis. In 42 subjects who underwent coronary calcium scanning, accuracy of FFR(CT) was 77.8% (n = 18), 100% (n = 11), and 100% (n = 13) for coronary calcium scores of 0-100, 101-400, and >400, respectively.


Accuracy of FFR(CT) is superior to CT stenosis for determining lesion-specific ischemia. The performance of FFR(CT) remains robust across an array of factors known to adversely affect CT quality.

[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center