Speckle blood perfusion imaging is a medical imaging technique that monitors blood perfusion information based on the scattering characteristics of red blood cells to the laser. Its benefits over traditional blood perfusion monitoring technologies include real-time imaging, high resolution, cheap cost, and the absence of contrast chemicals, particularly in surface blood flow monitoring. This review focuses on the basic principle of speckle blood perfusion imaging, technical advancements, and its application in monitoring fundus blood flow, cerebral blood flow, body surface microcirculation, and tumor blood perfusion, as well as its new application in monitoring angiogenesis of chicken embryo tumors.