Carotid imaging is key to effective secondary stroke prevention. It is commonly performed, but is a rather specialist procedure requiring regular practice to maintain acceptable accuracy. Previously the domain of the neuroradiologist, noninvasive carotid imaging is now widely practiced in general departments where specialist knowledge of anatomy and intracranial disorders may be less available. Noninvasive imaging is largely replacing intraarterial angiography in the assessment of carotid stenosis in most centres because the accuracy is perceived to be sufficient. However, effective stroke prevention needs to be delivered rapidly, guided by imaging tests that are used with an understanding of their limitations and accuracy. This review will discuss currently available imaging methods, their advantages and disadvantages, difficulties in determining their accuracy, current estimates of accuracy and gaps in knowledge.