Objective: To evaluate the values of Carotid Magnetic Resonance Imaging (MRI) in the differential diagnosis of symptomatic carotid stenosis and atherosclerotic plaque. Methods: 56 patients with ischemic cerebrovascular disease admitted in our hospital from October 2018 to October 2019 were selected and treated with Carotid MRI and digital subtraction angiography (DSA) examinations. According to the two examination results recorded and the “gold standard” of DSA examination, values of Carotid MRI in the differential diagnosis of symptomatic carotid stenosis were evaluated. Results: According to the “gold standard” of DSA examination, the sensitivity and specificity of MRI examination for carotid stenosis were: Mild: 92.54% and 97.78%; Moderate: 85.71% and 88.78%; Severe: 100.00% and 97.8%; and complete occlusion: 100.00% and 100.00%; The proportions of intraplaque haemorrhage and ruptured fibrous cap in different degrees of carotid artery stenosis were: Mild: 30.16% and 22.22%; Moderate: 43.48% and 39.13%; And severe: 57.89% and 52.63%. Conclusion: MRI examination can evaluate the degree of symptomatic carotid artery stenosis, and show the characteristics of atherosclerotic plaque at the same time to provide a reference for early clinical differential diagnosis and treatment.