- The accurate assessment of carotid artery disease is an important challenge for magnetic resonance (MR) angiography. Studies indicate that the detection and grading of stenosis and the evaluation of plaque morphology are all important steps in the clinical assessment of atherosclerosis. The prevalence of significant carotid artery stenosis in the elderly population and even in patients with symptoms of carotid artery disease is low; clinical risk seems to correlate more closely with plaque morphology and surface characterization than with the degree of stenosis. This highlights the importance of MR angiography and ultrasound, which can help characterize plaque morphology in addition to showing the degree of stenosis. The authors review the present understanding of plaque formation, comparisons of plaque imaging with conventional angiography, ultrasound, and MR angiography, and recent progress in MR angiography techniques. Several studies, including the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial, are discussed regarding the current objectives of carotid artery imaging. The sensitivity and specificity of plaque detection and morphologic evaluation continue to improve.