This chapter describes the mechanical image analysis using finite element (FE) method for atherosclerotic plaques. Q. Long combined computational fluid dynamics (CFD) modeling and MRI techniques together to perform patient-specific flow analysis based on in vivo magnetic resonance imaging (MRI) images from real patients. Phase contrast (PC) MRI was used to measure time varying inlet/outlet flow rates which are used as boundary conditions (BC) for the subject-specific CFD model. Image-based computational modeling is adding a new dimension (mechanical analysis) to atherosclerostic plaque image analysis. With advanced imaging and computational modeling techniques, atherosclerotic plaques can be analyzed under fluid-structure interaction environment and critical flow, and stress/strain conditions can be identified and used for more accurate plaque rupture risk assessment and predictions. Combination of imaging analysis, computational modeling, and clinical studies may lead to establishment of new industrial standard, gold standard for arterial disease assessment, and new noninvasive diagnostic and screening procedures.