All noninvasive imaging modalities that were discussed in this chapter are very useful in guiding clinical decisions in the cardiac patient. But in a world with limited resources, one must choose appropriately the test that may be the best to answer a specific clinical dilemma.

Given the recent adoption of MDCT technology, evidence to support improved clinical outcomes or reduced costs is lacking. One must recognize that outcome data will become available over time, with increased clinical utilization. Meanwhile, the high negative predictive value of this test makes it ideal for establishing or excluding CAD in patients with low-to-intermediate risk. When used as a primary test, a normal MDCT study virtually excludes the presence of CAD. MDCT studies that demonstrate the presence of atherosclerotic plaque without sig

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