Objective: To compare the use of 3.0T black blood MRI (BB-MRI) and DSA of the diagnosis of the middle cerebral artery (MCA) M1 segment stenosis and discuss the clinical value and of BB-MRI diagnosis of middle cerebral artery atherosclerotic stenosis. Methods:36 patients of ischemic cerebrovascular disease from Renji Hospital were chosen. These patients received both 3.0T BB-MRI and DSA were underwent within 1week. Comparison of BB-MRI and DSA for the evaluation of the middle cerebral artery atherosclerotic steno-occlusive and lesion length. Steno-occlusive were categorized as mild (0–50%), moderate (50–69%), severe (70–99%), or occlusive (no flow detected). The sensitivity, specificity, accuracy, negative predictive value, positive predictive value and Bland-Altman analysis were calculated using DSA as the golden standard. Results : Among 36 patients, there were 41 MCA M1 segments examined by BB-MRI and DSA . The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of mild degree MCA stenosis were 88.2%, 96.3%, 88% and 96.3%, respectively. In moderate stenosis were 45.5%, 96.7%, 71.4% and 97.1%, respectively. In severe stenosis were 80%, 94.0%, 50% and 98.4%, respectively. In occlusion were all approached up to 100%. Excellency agreement in measuring luminal stenosis (Spearman r=0.952) and lesion length (Spearman r=0.956) was found between BB-MR and DSA. Conclusions: The results of both BB-MRI and DSA showed a high coincidence of the two methods. With its fast acquisition and large coverage, BB-MRI can become an alternative choice for MCA atherosclerosis disease.