New developments in cardiac MRI and multidetector CT (MDCT) have generated tremendous excitement for both physicians and the general public. Their roles in the diagnostic algorithm of patients with suspected coronary artery disease are rapidly evolving. In addition to cardiac catheterization, nuclear imaging techniques and cardiac echocardiography, MDCT and MRI will play increasing roles in the diagnosis of ischemic heart disease. In this review we outline imaging techniques and illustrate the various applications of cardiac MRI and MDCT in the assessment of myocardial ischemia.