Purpose: To determine the usefulness and accuracy stress myocardial magnetic resonance (MR) perfusion imaging using steady-state free precession (SSFP) for depiction of myocardial ischemia in patients with ischemic heart disease. Materials and Methods: 167 patients underwent first-pass contrast-enhanced myocardial MR imaging at rest and adenosine-induced stress by using a 1.5-T cardiac MR imaging unit (Intera CV release 10; Philips Medical Systems, Best, Netherlands) equipped with high-performance gradients and a five-element phased-array cardiac coil. The first-pass MR perfusion(2744/1372 msec: TR/TE, 50쨘 flip angle, 256 x 256 matrix, 8 mm section thickness, 8-12 mm intersection gap) were acquired with a gradient echo sequence by using saturation-recovery steady-state free precession sequence (SR-SSFP). Coronary angiography was performed in 113 patients. Image analyses were performed to compare the diagnostic accuracies of MR imaging, with coronary angiography as the reference standard. Results: During the MR exam, minor side effects were occurred as chest discomfort (n =33), dyspnea (n= 5), and facial flushing (n= 1). The overall sensitivity of MR imaging for depicting at least one coronary artery with significant stenosis was 96% (82 of 85 patients). The sensitivities of MR imaging for depiction of single-, double-, and triple-vessel stenoses were 87% (13 of 15 patients), 96% (25 of 26 patients), and 100% (51 of 51 patients), respectively. The specificity of MR imaging for identification of patients with significant coronary artery stenoses was 78% (18 of 23 patients). Conclusion: Stress myocardial magnetic resonance (MR) perfusion imaging using steady-state free is safe and useful for the detection of ischemia in patient with ischemic heart disease.