The purpose of this study was to compare the image quality of multisegment and halfscan reconstructions of multislice computed tomography (MSCT) coronary angiography. 126 patients with suspected coronary artery disease and uninfluenced heart rates were examined by 16-slice CT before they underwent invasive coronary angiography. Multisegment and halfscan reconstructions were performed in all patients, and subjective image quality, overall vessel length, vessel length free of motion artefacts and contrast-to-noise ratios (CNRs) were compared for both techniques. The diagnostic accuracy of both approaches was compared with the results of invasive coronary angiography. Overall image quality scores of multisegment reconstruction were superior to those of halfscan reconstruction (13.3+/-2.1 vs 11.9+/-2.9; p<0.001). Multisegment reconstruction depicted significantly longer overall coronary vessel lengths (p<0.001) and larger vessel proportions free of motion artefacts in three of the four main coronary arteries. CNRs in the left main, left anterior descending and left circumflex coronary arteries were significantly higher when multisegment reconstruction was used (p<0.001). Overall accuracy was higher for multisegment reconstruction compared with halfscan reconstruction (87% vs 62%). In conclusion, multisegment reconstruction significantly improves image quality and diagnostic accuracy of MSCT coronary angiography compared with standard halfscan reconstruction, resulting in vessel lengths depicted free of motion comparable to those of CT performed in patients given beta-blockers to lower heart rates.