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Ce doped Gd3Al2Ga3O12 (Ce:GAGG) is a newly developed single-crystal scintillator which has a large light output and longer emission light wavelength. The longer wavelength of the scintillation photons will produce a larger signal when coupled to typical silicon photomultiplier (Si-PM) as the quantum efficiency of semiconductor based photodetector is generally higher for light with longer wavelength. A block detector with higher spatial resolution may thus be realized by combining Ce:GAGG with Si-PM arrays. To achieve the highest possible spatial resolution for PET and SPECT detectors, we developed an ultrahigh resolution block detector using 0.4 mm × 0.4 mm × 5 mm Ce:GAGG pixels assembled to form a 24 × 24 matrix that is coupled to an Si-PM array and evaluated the performance. All Ce:GAGG pixels were separated in the 2-dimensional position histograms for Cs-137 (662 keV) gamma photons with an average peak-to-valley (P/V) ratio of 2.4. The energy resolution was 21.6% FWHM for Cs-137 (662 keV) and 23.8% for Co-57 (122 keV) gamma photons. Since Ce:GAGG does not contain naturally occurring radioisotope (Lu), beta-gamma true coincidences can be avoided and randoms are reduced when used for PET detectors. Furthermore, this property, together with its high light output and good intrinsic energy resolution, make the scintillator suited for SPECT detectors. An ultrahigh resolution PET/SPECT hybrid system might be an interesting application using Ce:GAGG/Si-PM block detectors.