Non-invasive anatomical and functional imaging for the detection of coronary artery disease.

Coronary artery disease (CAD) is still an important cause of morbidity and mortality in the Western world. The gold standard for assessing significant coronary artery stenosis is invasive coronary angiography. Several disadvantages of the technique in combination with the fact that a substantial number of patients referred for conventional angiography appear free from significant stenosis have led to the pursuit of non-invasive imaging modalities for the diagnosis of CAD. The traditional modalities for this purpose are gated single-photon emission computed tomography, position emission tomography, (contrast) stress echocardiography and cardiac magnetic resonance (CMR), and these techniques can be characterized as functional imaging techniques as they detect ischaemia. Although the presence of a flow-limiting stenosis can be adequately ruled out with these techniques, atherosclerosis cannot be visualized with functional techniques. For this purpose, non-invasive coronary angiography techniques (computed tomography and CMR) are currently under development. The purpose of this review is to provide the reader an overview of the currently used imaging modalities to detect CAD.