Characterization of carotid artery morphology and plaque composition with MRI typically requires multiple measurements with different contrast weightings, which is limited by long scan time, image misregistration, and expertise-dependency in image interpretation. Recently, a new method, multi-contrast atherosclerosis characterization (MATCH) has been developed to overcome the above drawbacks by acquiring multi-contrast weighted images in one 5-min scan[1]. This study was conducted to determine the accuracy of MATCH in the characterization of plaque composition in patients in comparison with the conventional multi-contrast approach, using histopathology as the gold standard. Twenty-two patients scheduled for carotid endarterectomy underwent preoperative carotid MRI (one week prior to surgery) with MATCH and the conventional multi-contrast protocol (T1WI, T2WI, TOF) in the same examination using a 3T scanner and 8-channel carotid coil, relevant imaging parameters were summarized in Table 1. All image sets were processed using commercial plaque analysis software (MRI-Plaque View, VP Diagnostics). Blinded image review for composition identification was performed in consensus by 2 radiologists (with 2- and 9-year experience in carotid plaque MR characterization). The presence of intraplaque hemorrhage (IPH), calcification (CA), and lipid-rich necrotic core (LRNC) were determined using the criteria for the MATCH protocol[1], summarized in talbe 2, and those in a review article[2] for the conventional protocol. Carotid histopathological specimens were acquired from all patients and stained with HE and Masson. In all imaging and pathologic slices, plaques were examined by quadrant for the presence of atherosclerotic components[3]. Cohen kappa (K) was computed to quantify the agreement in the detection of components among the two protocols and histopathology.21 patients’ unilateral arteries yielded 66 cross-sections，divided to 244 quadrants and matched with MRI (multi-contrast protocol and MTACH) cross-sectional slices. One patient was excluded cause of image misregistration in conventional protocol. The statistical analysis was shown in table 3: In addition to sensitivity, specificity, Moderate to good agreement was seen between histopathological specimens and multi-contrast protocol in the detection of plaque components (IH k=0.704 , CA k=0.763, LR/NC k=0.844). Similar results were seen between histopathological specimens and MATCH (IH k=0.703CA k=0.740, LR/NC k=0.850). Our preliminary clinical study suggests that MATCH has similar performance in the evaluation of carotid plaque to the conventional multi-contrast protocol using histopathologic specimens as validation. Shorter scan time and less image misregistration have substantially reduced the examination failure rate. MATCH is a promising MRI method for assessing the risk of plaque disruption in a clinical workup.MRI；Multi-contrast Atherosclerosis Characterization (MATCH) protocol；Carotid artery atherosclerosis；Vulnerable plaque.