Aim: This retrospective study was to determine whether 3D-volume of epicardial adipose tissue (EAT) using 64-slice multi-detector cardiac computed tomography (MDCT) was associated with cardiovascular risk factors and coronary artery disease (CAD). Methods: In this study, a total 100 patients [non-CAD (group I): 71 patients, 57짹12 years, 34 males vs. CAD group (group II): 29 patients, 63짹10 years, 18 males] were enrolled. CAD was defined as diameter stenosis ��� 50% by MDCT. 3D-volume of EAT was obtained as gray scale image including intrathoracic fat and chest wall. In order not to overestimate the EAT, we compared to corresponding axial images and subtracted the intrathoracic fat outside visceral pericardium and chest wall as possible. Results: 1. Group II showed older age (p=0.022) and higher prevalence of diabetes mellitus (p=0.049) and hypertension (p=0.035) compared with group I. 2. 3D-volume of EAT was 133.57짹55.03 g in group I and 164.03짹50.96 g in group II. (p=0.012) 3. Coronary artery calcium score (CAC) was 18.96짹68.44 in group I and 220.93짹432.61 in group II (p=0.018) 4. Left carotid intima-media thickness (IMT) was 0.75짹0.13 mm in group I and 0.94짹0.23 mm in group II (p=0.036) 5. On bivariate correlation analysis, EAT 3D volume showed significant positive correlations with Right carotid IMT (r=0.746, p<0.0001) and CAC score (r=0.291, p=0.003). Conclusion: 3D-volume of EAT using MDCT is strongly predictive of cardiovascular risk factors and CAD.