Cardiac magnetic resonance (CMR) stress perfusion imaging is an advanced noninvasive method for assessing coronary artery disease (CAD), offering significant advantages over traditional imaging like nuclear perfusion. Contrast-enhanced stress perfusion CMR uses fast multi-slice imaging to evaluate myocardial perfusion, detecting both obstructive CAD and coronary microvascular disease (CMD). A key advancement is fully quantitative perfusion (QP), which improves diagnostic accuracy by creating perfusion maps and objectively diagnosing CMD. Stress-induced cardiac MRI typically uses pharmacological agents like adenosine and regadenoson to induce myocardial stress. Quantitative perfusion methods provide precise calculations of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR), with techniques like dual bolus imaging reducing signal saturation. While semiquantitative methods are still used, fully quantitative approaches offer more precision. AI-based contouring has improved image analysis, and stress MBF/MPR values are predictive of cardiovascular events. In conclusion, fully quantitative CMR stress perfusion is a promising tool for diagnosing and managing CAD and CMD, enhancing clinical decision-making and patient outcomes.