Carotid imaging techniques have become an increasingly popular part of the noninvasive cerebrovascular evaluation. Doppler ultrasound imaging diagrammatically recreates the vessel lumen when flow through that segment exceeds a threshold value, and anatomic information is inferred on the basis of this “physiologic image.” Real-time B-mode ultrasound carotid imaging is a direct anatomic evaluation of the carotid artery. The vessel wall and plaque are visualized as the definitive structure. These structures are visualized by sound wave reflection from the interfaces of tissues with different acoustic impedence.