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PURPOSEWe aimed to assess the diagnostic performance of transluminal attenuation difference (TAD) in predicting the severity of internal carotid artery (ICA) stenosis.METHODSThe study cohort consisted of 48 patients with 70%) stenosis compared with control arteries and low-moderate stenosis. A TAD ratio cutoff of 4.5 predicted 70%–99% stenosis with a sensitivity of 100% and specificity of 93%. The inter- and intraobserver agreements in TAD measurements were almost perfect (ICC, 0.89–0.86).CONCLUSIONAssessment of TAD ratio predicts the degree of stenosis in concordance with NASCET system.