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Purpose: To assess the utility of transluminal attenuation gradient (TAG) in combination with coronary computed tomography angiography (CTA) for detecting obstructive coronary artery stenosis.Materials and Methods: We retrospectively evaluated coronary CTA data in 35 consecutive patients who underwent invasive coronary angiography (ICA). We compared the diagnostic performance of TAG with that of quantitative coronary angiography, which we used as the reference standard. For the combination of TAG and coronary CTA, we designed a logical conjunction model (CCTA&&TAG) as well as a logical disjunction model (CCTA||TAG), and evaluated their diagnostic accuracies.Results: Among 130 vessels of 35 patients, 30 lesions (23%) showed significant stenosis on ICA. TAG predicted significant coronary artery stenosis with a sensitivity of 75%, specificity of 63%, positive predictive value of 40%, negative predictive value of 89%, and accuracy of 66%, and had a cutoff value of - 15.4 HU/10 mm. The respective values for CCTA&&TAG were 73, 98, 88, 90, and 90%; those for CCTA||TAG were 94, 61, 56, 94, and 72%. CCTA&&TAG improved the diagnostic accuracy significantly more than CCTA||TAG.Conclusion: TAG in conjunction with coronary CTA improves the diagnostic accuracy of coronary CTA. [ABSTRACT FROM AUTHOR]