fig3

Figure 3. Question-Directed Clinical Decision Framework for Noninvasive Imaging in CAD. The flowchart summarizes a question-directed approach to noninvasive imaging according to the presence of known CAD, clinical likelihood of obstructive disease, the primary diagnostic question, and patient-specific factors affecting test selection. Sequential testing should be used selectively when the initial examination leaves a clinically relevant anatomic or physiologic question unresolved. ANOCA/INOCA: Angina with no obstructive coronary arteries/ischemia with no obstructive coronary arteries; CAD: Coronary artery disease; CCTA: coronary computed tomography angiography; CMD: coronary microvascular dysfunction; CMR: cardiac magnetic resonance; CT-FFR: computed tomography-derived fractional flow reserve; ICA: invasive coronary angiography; LGE: late gadolinium enhancement; MBF: myocardial blood flow; MFR: myocardial flow reserve; PET: positron emission tomography; SPECT: single-photon emission computed tomography.