An atherosclerotic plaque with specific morphological features is more prone to rupture, and irregular luminal plaque surfaces are more prone to thrombus formation, thromboembolization and consequent acute events. Since computerized tomography angiography (CTA) can accurately grade the severity of carotid luminal stenosis, computerized tomography (CT) is increasingly used in the evaluation of stroke patients. CTA had a high degree of correlation with results of digital subtraction angiography (DSA) in the evaluation of carotid luminal stenosis. The main advantage of multidetector CT (MDCT) for carotid atherosclerotic plaque evaluation is the increased in-plane resolution, the decreased slice thickness and the subsequent ability to obtain near isotropic voxels. In MDCT the reconstructed slice thickness is independent of the detector collimation and is equal to or larger than the single detector collimation. MDCT can assess luminal surface morphology with the same or better accuracy than DSA.