Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, multidetector CT (MDCT) has the highest spatial resolution, allowing a detailed assessment of small vessel anatomy. We aimed to demonstrate the MSCT role in delineation of the extracardiac vascular abnormalities, and detect the common and uncommon findings in TOF cases for proper pre-surgical evaluation. Methods: This observational study was conducted on 54 patients with TOF diagnosed by echocardiography (ECHO) who underwent cardiac CT-angiography. All subjects underwent chest Xray, electrocardiogram, ECHO, cardiac MSCT. Results: CT examination revealed 3 cases of pulmonary atresia and 2 cases of absent left pulmonary artery were detected, 11% had left pulmonary artery osteal stenosis,5% had right pulmonary artery osteal stenosis,8% had abnormal aortic arch branching, , Conclusions: MDCT is a crucial for extra cardiac evaluation of TOF patients prior to surgical repair, identifying vascular abnormalities, additional VSDs and coronary anomalies.