Twenty years ago, theoretical developments were initiated to model the behavior of the NMR transverse relaxation rates in presence of vessels. These developments enabled the MRI-based mapping of mean vessel diameter, microvascular density, and vessel size index with comparable results to those obtained by a pathologist. The transfer of these techniques to routine clinical use has been hindered by the unavailability of the required sequences, namely fast gradient-echo spin-echo sequences. Based on the increasing accessibility of such sequences on MRI scanners over recent years, we review the principles governing microvascular MRI, the validation studies, and the applications that have been tested worldwide by several teams. We also provide some recommendations on how to measure microvessel caliber and density with MRI. Magn Reson Med 73:325–341, 2015. © 2014 Wiley Periodicals, Inc.