In the last 2 years, mechanical multidetector-row CT (MDCT) systems with simultaneous acquisition of four slices and a half second scanner rotation time have become widely available. Data acquisition with these scanners allows for considerably faster coverage of the heart volume compared with single slice scanning. This increased scan speed can be used for retrospective gating together with 1 mm collimated slice widths and allows coverage of the entire cardiac volume in one breath-hold. First results from studies in correlation with intracoronary ultrasound suggest that MDCT technology not only offers the possibility to visualize intracoronary stenoses non-invasively, but also to differentiate plaque morphology. This is especially the case with the next generation of 16-row MDCT systems. An increased number of simultaneously acquired slices and submillimetre collimation for cardiac applications allows true isotropic scanning with high temporal resolution. Contrast-enhanced MDCT is a promising non-invasive technique for the detection, visualization and characterization of stenotic artery disease. It could act as a gatekeeper prior to cardiac catherization and finally replace conventional diagnostic modalities.