Fatty acid imaging can measure fatty acid oxidation rates in heart or liver for research applications in animals and clinical applications in humans with metabolic disorders. Recent advances in fatty acid imaging using single photon emission computed tomography (SPECT) include the wide applications of the tracer beta-methyl-p-[ 123 I]-iodophenylpentadecanoic acid (BMIPP) to assess ischemic heart disease, cardiomyopathies, myocarditis, acute coronary syndrome, and heart failure and the design of new technetium-99m labeled tracers. In this mini-review article, several technetium-99m labeled fatty acid analogues as SPECT tracers are characterised, and the uptake of tracers, clearance from tissues, and mechanism of metabolism are discussed in detail. We subsequently summarized that some essential modification in fatty acid analogue structure can exert profound differences in the biodisposition and specificity of these tracers to improve the uptakes of fatty acids and prolong theirs retention in myocardium/hepatocyte. Thus, technetium-99m labeled fatty acid analogues have significant potential to play an important role as clinical SPECT traces of fatty acid oxidation in cardiovascular diseases, liver, and other applications in skeletal muscle and tumors.