The improvement also will foster the study and clinical use of newer applications of cardiac CT, such as coronary plaque characterization, late enhancement imaging for the detection of myocardial scar, and MPI to detect myocardial ischemia.1252 Efforts currently under way to obtain perfusion information from CCTA images are promising,196 201 with one report also calculating FFR with CCTA.195 Moreover, plaque quantification soft- ware is in development and could further guide accurate detection of atherosclerotic disease burden.1253 Several new developments in stress nuclear MPI have occurred, including new radioisotopes: 1) an F18 PET perfu- sion agent (in Phase III trials), which will allow exercise PET I-beta-methyl-iodophenylpentadecanoic acid SPECT, with the unique ability to document metabolic alterations representing prior ischemic episodes (ie, ischemic I-labeled meta-iodobenzylguanidine SPECT, which could be helpful for assessment of arrhythmic risk in SIHD patients.1254 Several new SPECT cameras also have been introduced into the marketplace and offer the opportunity for improved image quality within a substantially shorter time period and with a lower radiation dose.1255,1256 Several studies have correlated atherosclerotic plaque char- acteristics with the extent of ischemic myocardium by stress nuclear MPI.202 206,215 Finally, the diagnostic and prognostic value of PET flow reserve data is currently under intense Echocardiography, being the most portable and widely available stress imaging technique, has developed novel methods that are promising in the assessment of SIHD patient. Speckle-tracking echocardiography provides a 2-dimensional, angle-independent, real-time evaluation of myocardial strain and has been shown to detect myocardial ischemia incremental to wall motion analysis.1258,1259 Recent reports of contrast echocardiography MPI during vasodilating stress indicate that it is a potentially robust and clinically viable tool in detection of CAD.1260 Finally, 3-dimensional techniques can provide an improved assessment of cardiac size and function in patients with SIHD. 