Abstract: Quantitative measurement of myocardial blood flow (MBF) and coronary flow reserve (CFR) can be derived from myocardial perfusion imaging by using SPECT, single-photon tracers, and tracer kinetic techniques. The use of cadmium zinc telluride cadmium heart dedicated SPECT (CZT SPECT) enables faster and more accurate quantitative results. The determination of MBF and CFR is of great significance for improving the accuracy of coronary heart disease (CAD) diagnosis, re-stratification of CAD patients, and further prognosis evaluation. It can also provide an objective way for diagnosing coronary microvascular disease. However, some deficiencies need to be addressed. This article reviewed the different methods, preliminary results, and clinical significance of quantifying MBF and CFR with SPECT.