Abstract. Background/Aim: To evaluate the hypothesis that patients with suspected coronary artery disease (CAD) assessed using rest dual-energy computed tomography-derived myocardial perfusion imaging (DECT-P), could have fewer invasive coronary angiographies (ICA),Current guidelines in the management of stable coronary artery disease (CAD) recommend a non-invasive functional test before considering invasive coronary angiography (ICA) for patients with intermediate pre-test probability (1). Due to the high sensitivity and negative predictive value, coronary computed tomography angiography (cCTA) is a clinically-established noninvasive diagnostic imaging modality to rule-out CAD. However, the specificity and positive predictive value of cCTA is still limited due to the poor correlation of cCTA-detected coronary artery stenosis and myocardial ischaemia.One avenue for assessment of the myocardial blood supply consists of dual-energy computed tomography (DECT) acquisitions during first-pass arterial enhancement. Dualenergy computed tomography-derived myocardial perfusion imaging (DECT-P) is a "one-stop shop" approach closing the gap between anatomical and functional aspects within a single imaging modality and could reduce false-positive results of cCTA (2). As rest DECT-P is derived from the same datasets as standard cCTA, it requires no additional contrast media, radiation exposure, or stress agents, which represents a substantial advantage, when compared to stress protocols. Studies have compared DECT-P with single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), and ICA in rest or rest-stress acquisition with first or second generation dual-source scanners and found an incremental value over cCTA alone (3-6). However, the data for rest-only acquisition in DECT-P is rather sparse and needs further investigation regarding the clinical utility and its effect on patient care in a real clinical setting.Thus, the purpose of the present study was to test the hypothesis that patients with suspected CAD evaluated using a rest DECT-P strategy would potentially have fewer coronary angiographies without obstructive CAD than patients who were evaluated based on standard cCTA protocols.