Abstract: Myocardial perfusion single photon emission computed tomography (SPECT) imaging is an important routine diagnostic modality for coronary artery disease. In recent years, there have been continuous advancements in cardiac SPECT imaging instrument technology and image algorithm techniques, with a growing focus on quantitative assessment of myocardial blood flow, a research hotspot that integrates technical and clinical research. This article provides an overview of the development path of cardiac SPECT systems in terms of detector technology, system structure, collimation techniques, as well as SPECT image reconstruction algorithms and myocardial blood flow quantification methods. We briefly discuss the recent research hotspots and progress, highlighting the clinical value enhancement made possible by advancements in instrument technology.