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MR imaging is the criterion standard for carotid artery plaque characterization and is best able to characterize features of plaque vulnerability: lipid-rich necrotic core, intraplaque hemorrhage, ulcerations, loss of fibrous integrity, maximum plaque thickness, and plaque enhancement. Many researchers believe that many embolic strokes of undetermined source may originate from nonstenotic ipsilateral carotid plaques with vulnerable features. From the results of many trials, many believe that imaging markers of plaque vulnerability should be considered in the determination of carotid endarterectomy eligibility.