In this era of cost containment and evidence-based medicine, validation of a test’s diagnostic ability may be only the beginning step to its acceptance and use. In the imaging world, a test gains cost-effectiveness points if it not only is an independent predictor of outcomes but also adds prognostic information to pretest data. If the test can be used to risk-stratify patients, its value is further enhanced. This review discusses how one of the newer imaging techniques, single-photon emission CT, ranks with regard to the risk assessment of patients with coronary artery disease.