Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Beyond Coronary CT Angiography: CT Fractional Flow Reserve and Perfusion

전산화단층촬영 관상동맥조영술: 분획혈류예비력과 심근관류 영상

  • Moon Young Kim (Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Dong Hyun Yang (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ki Seok Choo (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Whal Lee (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • 김문영 (서울특별시보라매병원 영상의학과) ;
  • 양동현 (울산대학교 의과대학 서울아산병원 영상의학과) ;
  • 추기석 (부산대학교 의과대학 양산부산대학교병원 영상의학과) ;
  • 이활 (서울대학교 의과대학 서울대학교병원 영상의학과)
  • Received : 2021.11.15
  • Accepted : 2021.12.27
  • Published : 2022.01.01
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Abstract

Cardiac CT has been proven to provide diagnostic and prognostic evaluation of coronary artery disease for cardiovascular risk stratification and treatment decision-making based on rapid technological development and various research evidence. Coronary CT angiography has emerged as a gateway test for coronary artery disease that can reduce invasive angiography due to its high negative predictive value, but the diagnostic specificity is relatively low. However, coronary CT angiography is likely to overcome its limitations through functional evaluation to identify the hemodynamic significance of coronary artery disease by analyzing myocardial perfusion and fractional flow reserve through cardiac CT. Recently, studies have been actively conducted to incorporate artificial intelligence to make this more objective and reproducible. In this review, functional imaging techniques of cardiac computerized tomography are explored.

심장 전산화단층촬영은 비약적인 기술발전과 다양한 연구 결과를 바탕으로 심혈관위험 계층화와 치료 결정을 위한 관상동맥 질환의 진단과 예후 평가성능이 입증되었다. 전산화단층촬영 관상동맥조영술은 폐쇄성 관상동맥 질환에 대한 음성 예측도가 높아서 침습적 혈관조영술의 빈도를 줄일 수 있는 관상동맥 질환 관련 검사의 관문으로 부상했지만, 진단특이도가 상대적으로 낮다. 하지만 심장 전산화단층촬영을 이용한 분획혈류예비력과 심근관류를 분석하여 관상동맥 질환의 혈역학적 유의성을 확인하는 기능적 평가를 통해 그 한계를 극복할 수 있다. 최근에는 이를 보다 객관적이고 재현 가능하도록 인공지능을 접목하는 연구들이 활발히 진행되고 있다. 본 종설에서는 심장 전산화단층촬영의 기능적 영상화 기법들에 대해 알아보고자 한다.

Keywords

Acknowledgement

The authors are grateful to Seong Yong Pak (Siemens Healthineers, Seoul, South Korea) for his technical assistance in analyzing dynamic CT perfusion.

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