Determination of the actual cerebral hemodynamical status at the tissue level in patients with carotid artery disease remains one of the potential methods to determine the risk for recurrent, hemodynamically induced, symptoms in patients with carotid artery disease. Magnetic resonance imaging (MRI) offers two different approaches to measure the cerebral perfusion. The first technique, arterial spin labeling (ASL), exploits the water in blood as an endogenous tracer. Dynamic susceptibility contrast MRI (DSC-MRI or MR bolus tracking) is the alternative method. This method uses an intravenous injection of contrast agent, applied as an exogenous tracer. Both techniques have been used to study the CBF in patients with stenotic artery disease, showing their ability to provide important information on the hemodynamic status. Perfusion computed tomography (CT) is useful to evaluate the hemodynamic state of patients with chronic major cerebral artery occlusive disorders.