About 10% ~30% cases with typical angina pectoris were ascribed to cardiac syndrome X（CSX）. The prognosis of CSX is poor. However, there are no unified standards for diagnosis and treatment in the CSX. The role of medical imaging in the CSX is still unclear. Different medical imaging techniques have their specific advantages in evaluating the narrow degree of coronary artery, the coronary artery blood flow reserve, the cardiac anatomical, morphology and function, the myocardial perfusion, metabolism, and viability of the CSX. In this paper, the application of medical imaging in the CSX was reviewed.