Background: Multislice CT is a recent development in the spiral CT thatallows ECG-gated complete coronary coverage in a reasonable time.Atypical angina is chest pain or discomfort that lacks one of thecharacteristics of typical angina. It can arise from a variety of etiologiesincluding cardiac and non-cardiac causes. Cardiac chest pain may haveeither coronary artery disease (CAD) or non-CAD related etiologies.MDCT angiography plays an important role in patients with atypicalchest pain, where etiologies other than CAD are also in question. It canaccurately access CAD, anomalous coronary artery and pericardialdisease.Objectives: The aim of this study is to evaluate the role of multi-detectorrow CT angiography in patients presenting with atypical chest pain and todetect its ability to exclude significant CAD.Methods: This study included 50 patients, presenting with atypical chestpain showing initial negative ECG and troponin enzyme. Conventionalangiography was considered the reference standard technique for 20cases. Results of both modalities were compared on per-segment basisResults: Out of the 50 cases 9 (18%) patients were normal, 18 (32%)cases showed non-significant CAD and 19 (38%) cases showedsignificant coronary artery disease and 7 (14%) cases showed anomalouscoronary arteries. Zero calcium score was detected in 16 cases (32%)including one case showing significant CAD. Calcium score below 100 in20 cases (40%) and above 100 in 14 cases (28%).MDCT coronary angiography compared to CCA as reference standardshowed sensitivity, specificity, PPV, NPV & accuracy; 98%, 97.7%,90.5%, 99.5, 97.7% respectively.Conclusion: our results show that noninvasive 64-slice as well as dualsource CT coronary angiography is a reliable technique to detect coronarystenoses in patients presenting with atypical chest pain and suggest thatthis noninvasive technique can now be considered an alternative toinvasive diagnostic coronary angiography in this group of patients.