Fifty patients underwent 2DFT time-of-flight MR angiography and intraarterial contrast angiography for evaluation of possible carotid atherosclerotic disease. The MR angiography technique employed contiguous axial flow-sensitive (short TR/TE) slices that were reformatted and postprocessed by using a maximum-intensity projection algorithm to provide 16 angiographic views of the carotid arteries. Both studies were independently reviewed by two observers in a blinded manner. Carotid arteries were categorized as normal, mildly stenotic, moderately stenotic, severely stenotic, or occluded. For the 94 carotid arteries available for review, one observer reported a 70% agreement between the two techniques and the second observer reported a 56% agreement (p = .0001). The best correlation was in the severely stenotic category and the worst was in the occluded category. Agreement between observers was 67% for MR angiography and 72% for contrast angiography, which was similar to that between the two techniques. Although not all carotid atherosclerotic disease was visualized equally well, 2DFT time-of-flight MR angiography had a good overall correlation with the "gold standard" of intraarterial contrast angiography, supporting its use as a screening technique. While further improvements are needed, use of MR angiography as the primary diagnostic tool for many patients with suspected carotid stenosis should continue to increase.