High-accuracy diagnostic imaging is needed to diagnose and manage coronary artery disease as well as to allow risk stratification for future events. Advancements in multidetector computed tomography and image postprocessing allow for routine computed tomography coronary angiography to provide anatomic luminal assessment similar to invasive coronary angiography, and, similarly, computational fractional flow reserve derived from computed tomography facilitates determination of hemodynamically relevant stenosis comparable to invasive fractional flow reserve. In this review article, we describe the diagnostic performance and the potential impact of fractional flow reserve derived from computed tomography in clinical practice.