Rapid magnetic resonance imaging (MRI) of the heart, during the first pass of an injected contrast bolus is routinely used to detect hypoperfused myocardium, both at rest, and during vasodilator stress. Adapting this approach for quantitative perfusion imaging has been successfully tested and validated over more than 15 years in experimental models and clinical studies, yielding quantitative estimates of the perfusion reserve to detect epicardial stenoses and microvascular dysfunction, and to quantify absolute myocardial blood flow (in mL/minute/g of myocardial tissue). This review presents an overview of the most common approaches used in contrast-enhanced cardiac MRI for quantification of myocardial perfusion, and identifies some critical areas of current research. In its present state, cardiac MRI is a viable, diagnostically valuable alternative to other cardiac imaging modalities for the quantification of myocardial perfusion.