Coronary artery disease (CAD) is the number one cause of death globally and imaging plays a pivotal role in the diagnosis and management of CAD. With the improvements in technology, noninvasive imaging methods become more widely used in the management of CAD. Non-alcoholic fatty liver disease (NAFLD) is a clinicopathological syndrome which affects a substantial proportion of general population and is a component of the metabolic syndrome (MetS). Histopathologic analysis is the reference standard to detect and quantify fat in the liver, but results are vulnerable to sampling error. Imaging can be repeated regularly and allows assessment of the entire liver, thus avoiding sampling error so imaging is in key role in the management of NAFLD as in CAD. As NAFLD is a component of MetS, it is associated with increased risk for CAD. Recent studies suggest a more complex picture of the interrelation between NAFLD, MetS and CAD, and raised the possibility that NAFLD might not only be a marker but also an early mediator for CAD. So early detection of NAFLD and its management with noninvasive imaging methods can be very crucial in the control of CAD which is the number one cause of death globally.