Recent development of coronary imaging allows us to demonstrate myocardial ischemia in coronary artery disease (CAD) precisely and to guide the indication of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) more correctly based on coronary physiology. Catheter based fractional flow reserve (FFR) or instantaneous flow ratio (iFR) assessment can be demonstrated the degree and extend of perfusion abnormalities in each vessel separately even in cases with multi-vessel disease, and/or old myocardial infarction, in whom precise estimation of myocardial ischemia in each territory is reported to be difficult by exercise ECG, stress echocardiography or myocardial perfusion image. Furthermore, recent guideline and consensus document described these FFR and iFR as class I or IIa recommendation, especially in the assessment of intermediate coronary stenosis for assessing myocardial perfusion disturbance. Furthermore, there are many descriptions showing the improvement of prognosis by physiology-guided treatments compared with anatomy-based strategies. Moreover, possibilities of perfusion MRI or MSCT, and fusion image of MSCT coronary angiography with myocardial perfusion image were reported to be useful in the assessment of myocardial ischemia. Recent development in the field of computer science provided us to simulate fluid dynamics of coronary arteries and allowed us to calculate FFR values based on MSCT images or 3D-angiography as FFRCT or QFR, respectively. These advancement of the assessment of coronary ischemia may change our daily clinical practice. Thus, the advantages and disadvantages of each coronary imaging would be discussed in the assessment of myocardial ischemia and ideal diagnostic image tools of CAD for assessing myocardial ischemia would be discussed in this symposium.