Although coronary microvascular disease is now a well-recognized entity that is associated with significant morbidity and mortality, current non-invasive strategies cannot differentiate between coronary microvascular disease (CMD) and obstructive epicardial stenosis. While the evaluation of intramyocardial blood volume as a surrogate measure for microvascular health may have limited sensitivity in early-stage disease, this strategy does enable the diagnosis of CMD in the presence of concurrent epicardial disease, bringing us one step further toward improving the management of this disease. Herein, we discuss the advantages and limitations of current non-invasive measures of CMD and the need for further investment in bringing these technologies to the bedside.