Background: In this study, we aimed to investigate the efficacy of a 128-slice computed tomography (CT) device in detecting anatomical variations and anomalies of coronary arteries and to compare the results obtained with literature data. Methods: Totally, 83 patients (58 males, 25 females; mean age 53.7±10 years; range 31 to 80 years) with suspected or known coronary artery disease who underwent evaluation using the 128-slice CT in our clinic between February 2009 and December 2010 were retrospectively analyzed. All images were evaluated in terms of anatomic variation and anomaly by a radiologist with expertise in cardiovascular radiology. Continuous variables were expressed as arithmetical mean ± standard deviation (SD), while categorical variables were expressed as percent (%). Statistical analysis was performed using descriptive statistical tests. Results: The rate of right dominance, left dominance and co-dominance was 80.7%, 8.4% and 10.8%, respectively. It was observed that the conus artery originated from the right sinus valsalva at a rate of 16.86% and from the right coronary artery (RCA) at a rate of 83.1%. It was found that sinus node artery (SNA) originated from the RCA at a rate of 77.1%, from the circumflex (Cx) artery at a rate of 18.1%, from the left main coronary artery (LMCA) at a rate of 2.4% and from the right sinus valsalva at a rate of 2.4%. Ramus intermedius was present in 30.12% of the patients. Coronary artery anomaly was observed in 48 patients (57.8%). of them, 1.2% had absence of LMCA, 6% had commissural origin, 1.2% had coronary hypoplasia, 4.8% had anomalous of contralateral sinus origin, and 43.3% had myocardial bridging. Conclusion: The 128-slice CT device is a non-invasive method which provides reliable, detailed and correct information for detecting variations and anomalies of coronary arteries. We believe that the 128-slice CT is of higher value in diagnosis and surgical therapy of coronary artery anomalies.