The aim of this study was to determine the diagnostic performance of stress and rest perfusion magnetic resonance imaging (MRI) and late gadolinium-enhanced (LGE) MRI for identifying patients with obstructive coronary artery disease (CAD). A total of 50 patients with suspected CAD underwent stress-rest perfusion MRI, followed by LGE MRI with a 1.5-T system. Stress-rest perfusion MRI resulted in an area under the receiver-operating characteristic curve (AUC) of 0.92 for observer 1 and 0.84 for observer 2 with sensitivity and specificity of 89% (32/36) and 79% (11/14) by observer 1, 83% (30/36) and 71% (10/14) by observer 2, respectively, showing a moderate interobserver agreement (Cohen's kappa = 0.49). While combination of stress-rest perfusion and LGE MRI did not result in improved accuracy for the prediction of flow-limiting obstructive CAD (AUC 0.81 for observer 1 and 0.80 for observer 2), the sensitivity was increased to 92% in both observers with a substantial interobserver agreement (kappa = 0.70). Stress-rest myocardial perfusion MRI is an accurate diagnostic test for identifying patients with obstructive CAD.