Objective To explore the clinical value of real-time three-dimensional ultrasound (RT-3DU) VPQ technology diagnosis of carotid stenosis. Methods 102 patients of carotid plaque were examined with RT-3DU and CTA. The degree of stenosis with respect to the 130 locations of carotid plaque was evaluated. RT-3DU VPQ technology for off-line analysis was applied, such as carotid stenosis, the thickness of intima-media, the thickness of the narrowest plaque, NWI (normalized wall index) and the echo intensity of plaque. During the same period, the degree of carotid stenosis was detected CTA, the two methods was compared with each other. Results There was high consistency between RT-3DU and CTA. The locations of carotid plaque and the structure of carotid wall can be shown. RT-3DU showed mild stenosis in 15 cases, moderate stenosis in 78 cases and severe stenosis in 37 cases. CTA showed mild stenosis in 11 cases, moderate stenosis in 71 cases and severe stenosis in 48 cases. RT-3DU and CTA detection of carotid stenosis had a high consistency, and showed statistically significant (P<0.01). Conclusions RT-3DU VPQ technology could be determined carotid stenosis, easy and simple to handle, and capable of quantitative analysis of related indexes, while provided specific parameters, and its clinical application was very important.