Abstract: AIM The present investigation evaluated the results of dual-source computed tomography (DSCT) angiography for coronary stenosis assessment and analyzed the factors affecting the diagnostic accuracy of DSCT, using selective coronary angiography (SCA) as a reference standard. METHODS This retrospective analysis enrolled 156 patients diagnosed with coronary artery disease by DSCT angiography and then underwent selective coronary angiography. In total, 751 lesions in 1 369 segments were analyzed. The receiver operation characteristic (ROC) curve and area under curve of ROC (AUC) were used for statistical analysis. The influence of the characteristics of the lesions on the diagnostic performance of DSCT was evaluated. These characteristics of lesions included the extent of calcification, the lesion artery external diameter, the lesion length and the lesion location. RESULTS The AUC of severe calcified lesions was lower than those of moderate calcified lesions and mild calcified lesions (0.571 vs. 0.718, P<0.05 and 0.571 vs. 0.843, P<0.01, respectively). The AUC of lesions with artery external diameter<3 mm was lower than that of lesions with artery external diameter ≥3 mm (0.699 vs. 0.861, P<0.01). The AUC of lesions in the left circumflex was lower than those of lesions in the left anterior descending artery and lesions in the right coronary artery (0.724 vs. 0.836, P<0.05 and 0.724 vs. 0.853, P<0.05, respectively). CONCLUSION Severe calcification, lesion artery external diameter <3 mm and lesions in the left circumflex all are factors affecting the DSCT diagnostic accuracy of coronary stenosis.