Abstract Background: The main aim of carotid imaging studies is the assessment of the carotid plaque morphology with the detection of vulnerable plaques which is associated with increased risk of cerebrovascular insult, hence proper deline-ation of plaque composition is a crucial step for further management of brain ischemic insult. Aim of Study: To define the inter method agreement between the carotid ultrasound and carotid MRI for charac-terization of vulnerable plaques with further assessment of carotid ultrasound sensitivity and specificity. Material and Methods: The study was conducted over 60 patients. The modified G-W classification was used to assess the sonographic features of the carotid plaques, and compared with the plaque composition using carotid MRI. Results: Our study included 60 patients, their ages ranged between 53 and 78 years with a mean age of 60.3±9.8 years. 56.7% of patients was male. The agreement between carotid ultrasound and carotid MRI was good with k=0.734, sensitivity of the carotid ultrasound to detect the vulnerable plaque was 88.1% with an overall accuracy of 88.3%. Conclusion: The carotid ultrasound examination is con-sidered the first-line modality for assessment of the carotid plaque composition, with good agreement with carotid MRI and acceptable sensitivity and accuracy for characterization of vulnerable plaques.