Fractional Flow Reserve Computation Using 4D-CTA: A Computational Framework for Temporal Hemodynamic Assessment

Current fractional flow reserve computed tomography (FFRCT) methods rely on static imaging and standardized boundary conditions, potentially missing critical hemodynamic variations during the cardiac cycle. This study aimed to develop and validate a computational framework for dynamic FFRCT calculation using 4D-CTA data. We implemented an automated pipeline integrating 4D-CTA image processing, patient-specific geometric modeling, and computational fluid dynamics. Dynamic boundary conditions were derived from temporal flow measurements extracted from 4D-CTA data throughout the cardiac cycle. The methodology was validated through proof-of-concept studies on clinical datasets. Results demonstrated successful implementation of the automated 4D-CTA to CFD workflow with computational efficiency suitable for clinical applications. The framework effectively captured temporal hemodynamic variations and successfully computed dynamic FFR values throughout the cardiac cycle. Patient-specific boundary conditions based on actual flow measurements were successfully integrated, potentially addressing inter-patient variability limitations of standardized approaches. This study establishes the technical feasibility of dynamic FFRCT computation using 4D-CTA data. The developed framework may contribute to more physiologically relevant non-invasive coronary stenosis assessment, though further validation studies are needed to evaluate clinical utility and diagnostic accuracy.