Over the last decade, cardiac computed tomography (CT) technology has experienced revolutionary changes and gained broad clinical acceptance in the work-up of patients suffering from coronary artery disease (CAD). Since cardiac multidetector-row CT (MDCT) was introduced in 1998, acquisition time, number of detector rows and spatial and temporal resolution have improved tremendously. Current developments in cardiac CT are focusing on low-dose cardiac scanning at ultra-high temporal resolution. Technically, there are two major approaches to achieving these goals: rapid data acquisition using dual-source CT scanners with high temporal resolution or volumetric data acquisition with 256/320-slice CT scanners. While each approach has specific advantages and disadvantages, both technologies foster the extension of cardiac MDCT beyond morphological imaging towards the functional assessment of CAD. This article examines current trends in the development of cardiac MDCT.