In the past decade we have witnessed the development of noninvasive coronary imaging using different imaging modalities. Computed tomography (CT) and magnetic resonance imaging (MRI) modalities have been applied for the quantification of coronary calcium, detection of coronary and bypass graft occlusion, and most recently the characterization of noncalcified plaque material. However, the decisive application of noninvasive coronary CT or MRI, which determines whether it will find widespread clinical application, will be the detection of coronary stenosis. The first comparative study between MRI and conventional coronary angiography was published in 1993 (1), and numerous studies followed using various data acquisition techniques (2). Since 1997 a number of studies have compared electrocardiogram (ECG)-triggered electron beam computed tomography (EBCT) and conventional coronary angiography, also with promising results (3–9). In 1999, 4-slice multislice spiral computed tomography (MSCT) was introduced, and the first comparative publications appeared in 2001 (1–16). In 2002 the first results were published using 16-slice MSCT scanners with a submillimeter slice thickness and rotation time of less than a half second (17). In this chapter, we will discuss the practical considerations, diagnostic value, and remaining limitations of MSCT coronary imaging for the detection of coronary stenosis. The clinical utility and future developments will be discussed, as well as a comparison with other noninvasive imaging techniques.