Objectives: To investigate the relationship between plaque compositions and stenosis patterns in patients with atherosclerotic plaques at the carotid bifurcation using magnetic resonance (MR) imaging. Methods: One hundred and four carotid arteries with stenosis over 50% from 75 symptomatic stroke patients (64 male and 11 female; mean age 58.2 +/- 13.3 years) were studied. Plaque compositions were analyzed by high-resolution MR imaging using a 3.0T MR with a surface coil. Stenosis patterns were classified into three types according to contrast-enhanced MR angiography images. Correlations of different components of plaques and stenosis patterns were analyzed. Results: One hundred and four carotid arteries were analyzed. Three stenosis patterns were identified. The prevalences of the three patterns are as follows: type I (total occlusion) at 27.9% (29/104), type II (local plaque with normal distant flow) at 56.7% (59/104), and type III (local plaque with impaired distant flow) at 15.4% (16/104). The contingency coefficients between stenosis pattern and stability, intraplaque hemorrhage (IPH), lipid necrotic core (LNC), and ulcer were 0.383 (P=0.000), 0.290 (P=0.008), 0.439 (P=0.000), and 0.388 (P=0.000), respectively. Multinomial analysis showed that compared with type III vessels, type I vessels were more likely to contain IPH (P=0.019) and less likely to contain large LNC (P=0.001); type II vessels had a greater possibility for containing IPH than type III vessels (P=0.009); LNC was more likely to be found in type II than in type I vessels (P=0.000). No significant difference was found in ulceration prevalence between type II and type III vessels (P=0.058). Conclusions: The current study demonstrated positive associations between stenosis patterns and plaque compositions.