Purpose : To compare coronary CT angiography (CTA) with cardiac SPECT in patients with angina pectoris according to sexual difference Materials and methods : Thirty five female and forty one male patients with angina pectoris (Mean age: 66.7 짹 6.8 years in female, 62.6 짹 7.3 years in male) were prospectively enrolled for last three years. They were scheduled for invasive coronary angiography (ICA). They underwent both cardiac ECG gated SPECT and CTA using 16 and 64 multislice CT within three months before the ICA. The coronary arteries of CTA and ICA were assessed for the presence or absence of a significant stenosis (>50% luminal narrowing). Cardiac SPECT findings were classified as normal or abnormal (reversible or fixed defects). The diagnostic performance of CTA and cardiac SPECT according to sexual difference were analyzed on per patient basis. Results : In ICA, 29 out of 35 female patients and 35 out of 41 male patients had significant coronary artery stenosis (F/M: one vessel disease: 11/11, multivessel disease: 18/24, mild coronary artery obstructive disease: 5/5, normal: 1/1). Compared with ICA as the gold standard of reference, the diagnostic performances of CTA on per patient basis in both female and male patients showed better than cardiac SPECT. CTA on per patient basis correctly diagnosed 30 out of 35 patients (accuracy: 85.7%, sensitivity: 89.7%, specificity: 66.7%) in comparison with cardiac SPECT (22/35, 62.9% / 100% / 31.6% respectively) in the female patients. Fourteen false negative results on cardiac SPECT were all due to soft tissue attenuation artifacts in female patients. CTA on per patient basis correctly diagnosed 37 out of 41 patients (accuracy: 90.2%, sensitivity: 94.4%, specificity: 60.0%) in comparison with cardiac SPECT (30/41, 73.2% / 89.7% / 33.3%) in the female patients. Conclusion : Compared with cardiac SPECT, CTA showed better diagnostic performance in female patients with angina pectoris than male patients. CTA can be a useful noninvasive imaging test to evaluate the coronary artery stenosis in female patients with angina pectoris.