Findings of two-dimensional time-of-flight magnetic resonance (MR) angiography projection angiograms were prospectively compared with those of color Doppler sonography by using angiography as a standard in 23 consecutive patients (42 carotid bifurcations) to evaluate their utility in determining the presence of carotid artery stenosis. MR angiography helped detect 50% or greater lumen diameter stenosis (sensitivity, 0.96; specificity, 0.64). Color Doppler sonography with 1.25 m/sec peak systolic velocity as a threshold had a sensitivity of 0.96 and a specificity of 0.71. Statistical analysis showed a correlation between percentage of lumen diameter narrowing and the length of the zone of signal intensity loss with MR angiography (r = .69; P less than .0001). A stronger relationship was obtained between angiographic narrowing and peak systolic velocity derived from color Doppler sonography (r = .80; P less than .0001). Two-dimensional time-of-flight MR angiography displayed as projection angiograms and combined with carotid artery and combined with carotid artery sonography is a useful approach for helping detect and potentially grade the severity of stenoses of the carotid artery.