BACKGROUND: The purpose of this study is to assess the ability of dipyridamole99mTc-MIBI SPECT to identify and localize coronary artery disease(CAD). METHODS: The study population consists of 60 patients(37 males, 23 females : mean age 57+/-10 years) including 30 with prior myocardial infarction who underwent both dipyridamole99mTc-MIBI SPECT and coronary angiography for the evaluation of chest pain. RESULTS: The sensitivities for detection of CAD(> or =50% and > or =70% coronary stenosis by angiography) by dipyridamole99mTc-MIBI SPECT are 96% and 98% respectively, and specifities are 71% and 73% respectively. The sensitivities for detection of individual diseased vessels(> or =50% and > or =70%) are 79% and 90% for left anterior descending artery(LAD), 53% and 59% for left circumflex artery(LCX), 45% and 53% for right coronary artery(RCA), 64% and 77% for LCX/RCA, 63% and 72% for total. The specificities for detection of individual diseased vessels(> or =50% and > or =70%) are 62% for LAD, 98% and 98% for LCX, 92% and 89% for RCA, 91% and 89% for LCX/RCA, 87% and 86% for total. The concordances for ditection of individual didseased vessels beteen coronary angiography and dipyridamole99mTc-MIBI SPECT are all fair for SAD(Kappa=0.4 in > or =50% stenosis, 0.54 in > or =70% stenosis)LCX(Kappa=0.56,0.63),RCA(Kappa=0.4,0.44) and LCX/RCA(Kappa=0.56,0.67). CONCLUSION: Dipyriddamole99mTc-MIBI SPECT appers to be an useful noninvasive test for both identification and localization of coronary artery disease.