Background and Purpose - Concomitant disease of the supraaortic arteries can influence the outcome of surgical treatment of carotid artery stenosis. However, sensitivity and specificity data of noninvasive contrast- enhanced 3- dimensional (3D) magnetic resonance angiography (CE MRA) for the detection of stenoocclusive disease of the entire supra- aortic arteries including the circle of Willis remain unclear. We aimed to intra- individually compare high- spatial- resolution CE 3D MRA and digital subtraction angiography (DSA) for the assessment of steno- occlusive vascular disease of the supra- aortic arteries. Methods - CE MRA and DSA of the supra- aortic arteries were prospectively performed in 50 consecutive patients. Intra- individual comparison of CE MRA and DSA was available in 833 arteries. High- spatial- resolution CE MRA comprised a measured voxel size of 0.81 mm × 0.81 mm × 1 mm (0.66 mm3). Steno- occlusive vascular disease of the 833 arteries was assessed independently by 2 radiologists according to the NASCET criteria. Results - CE MRA had a sensitivity of 100% (73/73), a specificity of 99.3% (760/765), a positive predictive value of 93.6% (73/78), and a negative predictive value of 100% (760/760) by using a 70% to 99% threshold of arterial diameter stenosis. For detection of occlusion, sensitivity, specificity, PPV, and NPV value of CE MRA were 100% , respectively. Conclusions - Noninvasive high- spatial- resolution CE MRA is suited to replace diagnostic DSA for the detection of stenoocclusive disease of the supra- aortic arteries. Background and Purpose - Concomitant disease of the supraaortic arteries can influence the outcome of surgical treatment of carotid artery stenosis. However, sensitivity and specificity data of noninvasive contrast-enhanced 3- dimensional (3D) magnetic resonance angiography (CE MRA) for the detection of stenoocclusive disease of the entire supra- aortic arteries including the circle of Willis remain unclear. We aimed to intra-individually compare high- spatial-resolution CE 3D MRA and digital subtraction angiography (DSA) for the assessment of steno- occlusive vascular disease of the Methods-CE MRA and DSA of the supra- aortic arteries were prospectively performed in 50 consecutive patients. Intra-individual comparison of CE MRA and DSA was available in 833 arteries. High- spatial- resolution CE MRA comprised a measured voxel size of 0.81 mm × 0.81 mm × 1 mm (0.66 mm3). Steno- occlusive vascular disease of the 833 arteries was highly independently by 2 Results of CE MRA with a sensitivity of 100% (73/73), a specificity of 99.3% (760/765), a positive predictive value of 93.6% (73/78), and a negative Predictive value of 100% (760/760) by using a 70% to 99% threshold of arterial diameter stenosis. For detection of occlusion, sensitivity, specificity, PPV, and NPV value of CE MRA were 100%, respectively. Conclusions - Noninvasive high spatial-resolution CEA is suitable to replace diagnostic DSA for the detection of stenoocclusive disease of the supra-aortic arteries.