Published 16 January 2012 Stroke and heart attack, which could be led by a kind of cerebrovascular and cardiovascular disease named as atherosclerosis, would seriously cause human morbidity and mortality. It is important for the early stage diagnosis and monitoring medical intervention of the atherosclerosis. Carotid stenosis is a classical atherosclerotic lesion with vessel wall narrowing down and accumulating plaques burden. The carotid artery of intima-media thickness (IMT) is a key indicator to the disease. With the development of computer assisted diagnosis technology, the imaging techniques, segmentation algorithms, measurement methods, and evaluation tools have made considerable progress. Ultrasound imaging, being real-time, economic, reliable, and safe, now seems to become a standard in vascular assessment methodology especially for the measurement of IMT. This review firstly attempts to discuss the clinical relevance of measurements in clinical practice at first, and then followed by the challenges that one has to face when approaching the segmentation of ultrasound images. Secondly, the commonly used methods for the IMT segmentation and measurement are presented. Thirdly, discussion and evaluation of different segmentation techniques are performed. An overview of summary and future perspectives is given finally.