Purpose: To investigate intraplaque hemorrhage (IPH) development and change over time. Materials and Methods: Institutional review board approval and written informed consent from all participants were obtained. From a population-based study on subclinical atherosclerosis, 40 participants with IPH at baseline magnetic resonance (MR) imaging (53 carotids with IPH) were randomly selected and were matched with 27 control subjects (53 carotids without IPH) to undergo a second MR examination (mean interval, 17 months 6 4 [standard deviation]) to assess IPH change. IPH volume change was evaluated by using both a visual rating scale and an automated volumetric segmentation tool. Cardiovascular risk factors for IPH volume change were investigated with linear regression analyses. Results: IPH remained present in 50 (94%) of the 53 carotids with IPH at baseline, and it developed in fve (7%) of the 40 carotids without IPH at baseline. Visual progression of IPH volume was present in 14 (26%) of the 53 carotids with IPH at baseline, and regression was present in 16 (30%). Mean quantitative change in IPH volume was 213.7 mm3 ± 62.6 per year of follow-up. Male sex (men vs women, 37.7 mm3; 95% confdence interval [CI]: 11.0, 64.4; P =.006), smoking (smokers vs nonsmokers, 45.2 mm3; 95% CI: 7.1, 83.4; P =.020), and hypertension (subjects with hypertension vs those without hypertension, 32.5 mm3; 95% CI: 7.7, 57.2; P =.010) were associated with IPH volume change. Conclusion: During 17 months of follow-up, both visual progression and regression of IPH volume occurs, whereas quantitatively IPH volume decreases. This suggests that IPH is a dynamic process with potential for either growth or resolution over time.