Aim This study applied contrast-enhanced ultrasound (CEUS) association with gray-scale median(GSM) technique and region of interest traking to analyse contrast-enhanced intensity visual grading, the contrast parameters and GSM. It is to objectively and quantitatively evaluate the formation of intraplaque neovascularization in different echogenicity of carotid artery plaque and provide the imaging basis to evaluate the stability of carotid atherosclerotic plaque noninvasively and quantitatively. Methods Using conventional ultrasound to obtain the GSM of 64 carotid plaque and divide into four groups. The contrast-enhanced intensity visual grading, the contrast parameters and GSM of the four groups of plaques were achieved after CEUS to analyze their differences. Analyze the correlation between the contrast parameters and GSM of these plaques. Results There was statistical difference in the GSM among groups (F=29.365,P<0.001). There were statistical difference in the enhanced intensity of contrast-enhanced ultrasound enhanced visual score rating of different carotid atherosclerotic plaque echogenicity(χ²=17.951,P<0.001). Compared the contrast-enhanced ultrasound parameters among groups:the enhanced intensity (χ²=29.025, P<0.001) and the enhanced density (χ²=30.871, P<0.001) of the four groups of plaques had statistical difference; There were statistical difference in the enhanced intensity of different grading(χ²=23.709, P<0.001). The enhanced intensity and GSM of plaque have a significantly negative correlation(r=－0.376,P=0.000); The enhanced density and GSM of plaque have a significantly negative correlation(r=－0.252,P=0.000). Our results suggest that the more anechoic lesions and the lower GSM the higher value of contrast-enhanced intensity and enhanced density. It will indirectly suggest that these plaques which have more neovascularization are more unstable and more likely to have cerebral vascular incidence. Conclusions CEUS combined with GSM technology can more objectively and quantitatively evaluate the formation of intraplaque neovascularization in different echogenicity of carotid artery plaque. It will provide the imaging basis to evaluate the stability of carotid atherosclerotic plaque noninvasively and quantitatively. It might be helpful for clinical.