Current fractional flow reserve computed tomography (FFRCT) methods use static imaging, potentially missing critical hemodynamic changes during the cardiac cycle. We developed a novel dynamic FFRCT framework using 4D-CTA data to capture temporal coronary dynamics throughout the complete cardiac cycle. Our automated pipeline integrates 4D-CTA processing, temporally weighted geometric modeling, and patient-specific boundary conditions derived from actual flow measurements. Preliminary validation in three patients (four vessels) showed that dynamic FFRCT values (0.720, 0.797, 0.811, and 0.952) closely matched invasive FFR measurements (0.70, 0.78, 0.78, and 0.94) with improved accuracy compared to conventional static methods. The dynamic approach successfully captured physiologically relevant hemodynamic variations, addressing inter-patient variability limitations of standardized approaches. This study establishes the clinical feasibility of dynamic FFRCT computation, potentially improving non-invasive coronary stenosis assessment for clinical decision-making and treatment planning.
Keywords: 4D-CTA; dynamic hemodynamics; fractional flow reserve; patient-specific modeling.