Functional versus anatomic imaging in patients with suspected coronary artery disease

Patients with suspected or known coronary artery disease often require evaluation by cardiac imaging tests. The purpose of these tests may vary according to each individual patient, from establishing or ruling out obstructive coronary artery disease as the cause of symptoms to determining the risk of future cardiac events and guiding the selection of medical therapy and revascularization. With the adoption of cardiac CT, most patients can have a complete evaluation noninvasively. The challenge is to determine when anatomical evaluation of coronary artery disease or functional evaluation of the burden of ischemia may be required. This article reviews the relative value of anatomical versus functional imaging and their complementary role in different clinical scenarios.