Purpose: This study sought to determine the feasibility of texture analysis for the classification of American Heart Association (AHA) type Ⅳ-V and type Ⅵ carotid atherosclerotic lesions at multi-contrast black-blood MR images. Methods: A cross-sectional study was performed on 24 patients (16 men, mean age of 67.1 + 10.9 years) with carotid stenosis >50% detected by ultrasound. All subjects underwent a standard multi-contrast vessel wall MR protocol. MRI-modified AHA criteria was used to evaluate carotid atherosclerotic lesion type and each cross-sectional location was evaluated. The main criterion for inclusion in the study is the presence of type Ⅳ-V and type Ⅵ carotid atherosclerotic lesions. All patients were imaged using a 3.0T MRI scanner (Philips Achieva, Best, Netherlands) with an 8-channel phased-array carotid coil. A standardized imaging protocol was performed to obtain multi-contrast cross-sectional MR images, including time-of-flight (TOF), T1W, T2W, MP-RAGE and contrast-enhanced (CE)-T1W imaging of the bilateral carotid arteries centered on the bifurcation. We used the texture analysis software to generate reproducible regions of interest (ROIs) for all type Ⅳ-V and type Ⅵ carotid lesions on T1W, T2W and CE-T1W images. Then, texture features derived from the gray-level histogram, co-occurrence and run-length matrix, gradient, autoregressive model, and wavelet transform were calculated. To identify the most valuable texture features for distinguishing between type Ⅳ-V and type Ⅵ lesions, top 3 subsets of each 10 texture features were extracted, independently for T1W, T2W and CE-T1W sequences. Fisher, probability of classification error and average correlation (POE + ACC), and mutual information (MI) coefficients were used to extract subsets of optimized texture features. Linear discriminant analysis (LDA) was used for lesion classification. Results: Four patients showed considerable artifacts on carotid MR images. Of the remaining 20 subjects, 16 were male (80 %) and the mean age was 62.1 ± 10.2 years. In total, 23 arteries had 26 location with type Ⅵ lesions, 31 location with type Ⅳ-V lesions. Of the arteries with AHA- type Ⅵ, 88.5% had hemorrhage and 11.5% had a ruptured fibrous cap. On pre- and postcontrast T1-weighted images, top 3 texture features that were selected based on the Fisher and MI coefficients were predominantly derived from the co occurrence matrix, whereas feature subsets created using the POE + ACC method included features from all categories except the run-length matrix. LDA produced misclassification rates of 1.75–8.77% on T1W, 24.56–36.84% on T2W images, and 26.32–35.09% on CE-T1W images. The discrimination distribution of the three statistical analysis approaches shows that POE + ACC on T1W has the largest discrimination power to distinguish the two texture categories. Conclusions: Our preliminary study results suggest that texture-based pattern classification of advanced carotid atherosclerotic lesions is feasible on MR images, even without the administration of contrast media. This preliminary evaluation indicates that carotid plaque texture analysis is a potentially useful adjunct tool for comprehensive and quantitative evaluation of atherosclerotic plaque vulnerability.