Carotid MR images of a 66-year hypertensive female with left ICA stenosis detected following right upper limb paresis. TOF images (a, b) showed mildly hyperintense plaque (arrows) involving carotid bulbs extending into the proximal left ICA causing ~ 80% stenosis. T1 image (c) showed the plaque to have iso-hyperintense areas, which showed hyperintensity in PD (d) compared to T2 (e), suggesting lipid-rich plaque. The plaque, as identified better in a T2 FS (f) image, showed hyperintense areas in and DWI (g) with an ADC value (inset, g) of 0.41 x 10-3mm2/sec. Post endarterectomy, histopathological analysis (h, i) showed necrotic lipid core with inflammatory cell infiltrate (arrows in h - Haematoxylin and Eosin, original magnification 50X, Scale bar 200 μm, i - Original magnification 100X, Scale bar 100 μm).