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• Clinical Article •
Correlation study of atherosclerotic plaques in the middle cerebral artery with recurrent stroke assessed by magnetic resonance vascular wall imaging
WEN Xinru  LIN Guohui  SONG Jianxun 

Cite this article as: WEN X R, LIN G H, SONG J X. Correlation study of atherosclerotic plaques in the middle cerebral artery with recurrent stroke assessed by magnetic resonance vascular wall imaging[J]. Chin J Magn Reson Imaging, 2025, 16(4): 25-32. DOI:10.12015/issn.1674-8034.2025.04.005.


[Abstract] Objective Magnetic resonance vascular wall imaging (MR-VWI) was used to analyze the characteristics of intracranial atherosclerotic plaques in patients with ischemic stroke in the middle cerebral artery region, and to explore the imaging features independently associated with recurrent stroke.Materials and Methods A total of 185 patients with middle cerebral artery atherosclerosis were retrospectively selected from our hospital. All patients completed MR-VWI examination and were determined to have responsible plaque in the middle cerebral artery in the infarction area. According to the clinical and imaging data, the patients were divided into three groups, namely the first stroke group, the recurrent stroke group and the negative stroke group. Plaque characteristics, China Ischemic Stroke Subclassification (CISS), and other imaging indicators were recorded. The differences of clinical data and imaging features among the three groups were compared, and the risk factors related to ischemic stroke recurrence were further screened by logistic regression analysis. The area under the curve (AUC) corresponding to the receiver operating characteristic curve was calculated for the independent correlation factors obtained from the multi-factor analysis.Results A total of 185 patients were included, including 69 patients in the first stroke group, 76 patients in the recurrent stroke group and 40 patients in the negative stroke group. There was no significant difference in gender among the three groups (P > 0.05). Compared with the first stroke group and the stroke negative group, patients in the recurrent stroke group were older (P < 0.05) and had a higher proportion of diabetes (P < 0.05). Compared with the negative stroke group, the proportion of middle-aged and elderly patients over 45 years old in the first stroke group and the recurrent stroke group was higher (P = 0.006, P< 0.001), and the proportion of diabetes in the recurrent stroke group was higher (P = 0.013). Ring-wall plaques were more common in the first stroke group than in the negative stroke group (P = 0.008). In the first stroke group and the recurrent stroke group, the plaque area, plaque load and degree of stenosis were larger, and the number of enhanced plaques was more (P < 0.05). Compared with the recurrent stroke group, the mechanism of stroke in the recurrent stroke group was more inclined to the type of low perfusion/embolus removal disorder in the CISS classification (P = 0.046), and the recurrent stroke group had larger plaque area (P < 0.001), plaque load (P < 0.001), and more obvious stenosis (P < 0.001). Multivariate logistic regression analysis showed that age, plaque area and plaque load were independent risk factors associated with ischemic stroke recurrence in the middle cerebral artery region (P < 0.05). Age [odds ratio, OR = 1.040, 95% confidence interval (CI): 1.007 to 1.074, P = 0.008], plaque area (OR = 1.286, 95% CI: 1.018 to 1.543, P = 0.002), plaque load (OR = 1.586, 95% CI: 1.013 to 2.155, P < 0.001). The AUC of age was 0.658 (95% CI: 0.568 to 0.748), the AUC of plaque area was 0.662 (95% CI: 0.575 to 0.750), and the AUC of plaque load was 0.758 (95% CI: 0.676 to 0.839). The AUC value of the combined detection of the three factors was 0.827 (95% CI: 0.758 to 0.896), which was higher than the AUC value of other independent predictors, and the overall prediction efficiency was the best.Conclusions Age, plaque area and plaque load are independently associated with the recurrence of middle cerebral artery ischemic stroke.
[Keywords] ischemic stroke；recurrent stroke；magnetic resonance imaging；vascular wall imaging；plaques

WEN Xinru   LIN Guohui   SONG Jianxun*  

Room of MR, Shenzhen Baoan People's Hospital, Shenzhen 518100, China

Corresponding author: SONG J X, E-mail: songjianxun@126.com

Conflicts of interest   None.

Received  2024-11-24
Accepted  2025-03-10
DOI: 10.12015/issn.1674-8034.2025.04.005
Cite this article as: WEN X R, LIN G H, SONG J X. Correlation study of atherosclerotic plaques in the middle cerebral artery with recurrent stroke assessed by magnetic resonance vascular wall imaging[J]. Chin J Magn Reson Imaging, 2025, 16(4): 25-32. DOI:10.12015/issn.1674-8034.2025.04.005.

[1]
GUTIERREZ J, TURAN T N, HOH B L, et al. Intracranial atherosclerotic stenosis: risk factors, diagnosis, and treatment[J]. Lancet Neurol, 2022, 21(4): 355-368. DOI: 10.1016/S1474-4422(21)00376-8.
[2]
Report on Stroke Prevention and Treatment in China Writing Group. Brief report on stroke prevention and treatment in China[J]. Chin J Cerebrovasc Dis, 2023, 20(11): 783-793. DOI: 10.3969/j.issn.1672-5921.2023.11.009.
[3]
KOLMOS M, CHRISTOFFERSEN L, KRUUSE C. Recurrent Ischemic Stroke - A Systematic Review and Meta-Analysis[J/OL]. J Stroke Cerebrovasc Dis, 2021, 30(8): 105935 [2024-11-24]. https://pubmed.ncbi.nlm.nih.gov/34153594/. DOI: 10.1016/j.jstrokecerebrovasdis.2021.105935.
[4]
WANG Y, ZHAO X, LIU L, et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) Study[J]. Stroke, 2014, 45(3): 663-669. DOI: 10.1161/STROKEAHA.113.003508.
[5]
LIN G H, SONG J X, HUANG T D, et al. Relationship between the stroke mechanism of symptomatic middle cerebral artery atherosclerotic diseases and culprit plaques based on high-resolution vessel wall imaging[J/OL]. Front Neurol, 2022, 13: 968417 [2024-11-24]. https://pubmed.ncbi.nlm.nih.gov/36188409/. DOI: 10.3389/fneur.2022.968417.
[6]
MA Z, HUO M, XIE J, et al. Wall characteristics of atherosclerotic middle cerebral arteries in patients with single or multiple infarcts: A high-resolution MRI Study[J/OL]. Front Neurol, 2022, 13: 934926 [2024-11-24]. https://pubmed.ncbi.nlm.nih.gov/36408522/. DOI: 10.3389/fneur.2022.934926.
[7]
CHOJDAK-LUKASIEWICZ J, DZIADKOWIAK E, ZIMNY A, et al. Cerebral small vessel disease: A review[J]. Adv Clin Exp Med, 2021, 30(3): 349-356. DOI: 10.17219/acem/131216.
[8]
TENG Z, PENG W, ZHAN Q, et al. An assessment on the incremental value of high-resolution magnetic resonance imaging to identify culprit plaques in atherosclerotic disease of the middle cerebral artery[J]. Eur Radiol, 2016, 26(7): 2206-2214. DOI: 10.1007/s00330-015-4008-5.
[9]
LIU S, TANG R, XIE W, et al. Plaque characteristics and hemodynamics contribute to neurological impairment in patients with ischemic stroke and transient ischemic attack[J]. Eur Radiol, 2021, 31(4): 2062-2072. DOI: 10.1007/s00330-020-07327-1.
[10]
YAMAGISHI M, TERASHIMA M, AWANO K, et al. Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome[J]. J Am Coll Cardiol, 2000, 35(1): 106-111. DOI: 10.1016/s0735-1097(99)00533-1.
[11]
QIAO Y, ANWAR Z, INTRAPIROMKUL J, et al. Patterns and Implications of Intracranial Arterial Remodeling in Stroke Patients[J]. Stroke, 2016, 47(2): 434-440. DOI: 10.1161/STROKEAHA.115.009955.
[12]
LOU X, MA N, SHEN H, et al. Noninvasive visualization of the basilar artery wall and branch ostia with high-resolution three-dimensional black-blood sequence at 3 tesla[J]. J Magn Reson Imaging, 2014, 39(4): 911-916. DOI: 10.1002/jmri.24222.
[13]
XIAO J, SONG S S, SCHLICK K H, et al. Disparate trends of atherosclerotic plaque evolution in stroke patients under 18-month follow-up: a 3D whole-brain magnetic resonance vessel wall imaging study[J]. Neuroradiol J, 2022, 35(1): 42-52. DOI: 10.1177/19714009211026920.
[14]
SEN S, MEYER J, MASCARI R, et al. Association of Dental Infections with Intracranial Atherosclerotic Stenosis[J]. Cerebrovasc Dis, 2024, 53(1): 28-37. DOI: 10.1159/000530829.
[15]
DIELEMAN N, YANG W, ABRIGO J M, et al. Magnetic Resonance Imaging of Plaque Morphology, Burden, and Distribution in Patients With Symptomatic Middle Cerebral Artery Stenosis[J]. Stroke, 2016, 47(7): 1797-1802. DOI: 10.1161/STROKEAHA.116.013007.
[16]
WU G, WANG H, ZHAO C, et al. Large Culprit Plaque and More Intracranial Plaques Are Associated with Recurrent Stroke: A Case-Control Study Using Vessel Wall Imaging[J]. AJNR Am J Neuroradiol, 2022, 43(2): 207-215. DOI: 10.3174/ajnr.A7402.
[17]
FLACH C, MURUET W, WOLFE C, et al. Risk and Secondary Prevention of Stroke Recurrence: A Population-Base Cohort Study[J]. Stroke, 2020, 51(8): 2435-2444. DOI: 10.1161/STROKEAHA.120.028992.
[18]
CAMPBELL B, DE SILVA D A, MACLEOD M R, et al. Ischaemic stroke[J/OL]. Nat Rev Dis Primers, 2019, 5(1): 70 [2024-11-24]. 10.1038/s41572-019-0118-8. DOI: 10.1038/s41572-019-0118-8.
[19]
KRINOCK M J, SINGHAL N S. Diabetes, stroke, and neuroresilience: looking beyond hyperglycemia[J]. Ann N Y Acad Sci, 2021, 1495(1): 78-98. DOI: 10.1111/nyas.14583.
[20]
WABNITZ A M, DERDEYN C P, FIORELLA D J, et al. Hemodynamic Markers in the Anterior Circulation as Predictors of Recurrent Stroke in Patients With Intracranial Stenosis[J]. Stroke, 2019, 50(1): 143-147. DOI: 10.1161/STROKEAHA.118.020840.
[21]
FENG X, CHAN K L, LAN L, et al. Stroke Mechanisms in Symptomatic Intracranial Atherosclerotic Disease: Classification and Clinical Implications[J]. Stroke, 2019, 50(10): 2692-2699. DOI: 10.1161/STROKEAHA.119.025732.
[22]
YANG X Y, WANG Y, SU C, et al. Correlation between small cerebral vascular disease and recurrent ischemic stroke[J]. J Apoplexy and Nervous Diseases, 2022, 39(6): 562-564. DOI: 10.19845/j.cnki.zfysjjbzz.2022.0146
[23]
DUERING M, BIESSELS G J, BRODTMANN A, et al. Neuroimaging standards for research into small vessel disease-advances since 2013[J]. Lancet Neurol, 2023, 22(7): 602-618. DOI: 10.1016/S1474-4422(23)00131-X.
[24]
KWAN A, WEI J, DOWLING N M, et al. Cognitive Impairment after Lacunar Stroke and the Risk of Recurrent Stroke and Death[J]. Cerebrovasc Dis, 2021, 50(4): 383-389. DOI: 10.1159/000514261.
[25]
YAMAMOTO Y, NAGAKANE Y, TOMII Y, et al. High Morning and Bedtime Home Blood Pressures Strongly Predict for Post-Stroke Cognitive Impairment[J]. J Stroke Cerebrovasc Dis, 2016, 25(8): 1856-1863. DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.001.
[26]
WANG Y, LIU X, WU X, et al. Culprit intracranial plaque without substantial stenosis in acute ischemic stroke on vessel wall MRI: A systematic review[J]. Atherosclerosis, 2019, 287: 112-121. DOI: 10.1016/j.atherosclerosis.2019.06.907.
[27]
SUO Y, JING J, PAN Y, et al. Concurrent intracranial and extracranial artery stenosis and the prognosis of transient ischaemic symptoms or imaging-negative ischaemic stroke[J]. Stroke Vasc Neurol, 2021, 6(1): 33-40. DOI: 10.1136/svn-2020-000377.
[28]
SUN P, LIU L, PAN Y, et al. Intracranial Atherosclerosis Burden and Stroke Recurrence for Symptomatic Intracranial Artery Stenosis (sICAS)[J]. Aging Dis, 2018, 9(6): 1096-1102. DOI: 10.14336/AD.2018.0301.
[29]
QIAO Y, ZEILER S R, MIRBAGHERI S, et al. Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial-resolution MR images[J]. Radiology, 2014, 271(2): 534-542. DOI: 10.1148/radiol.13122812.
[30]
RAN Y, WANG Y, ZHU M, et al. Higher Plaque Burden of Middle Cerebral Artery Is Associated With Recurrent Ischemic Stroke: A Quantitative Magnetic Resonance Imaging Study[J]. Stroke, 2020, 51(2): 659-662. DOI: 10.1161/STROKEAHA.119.028405.
[31]
ZHOU M, YU Y, CHEN R, et al. Wall shear stress and its role in atherosclerosis[J/OL]. Front Cardiovasc Med, 2023, 10: 1083547 [2024-11-24]. https://pubmed.ncbi.nlm.nih.gov/37077735/. DOI: 10.3389/fcvm.2023.1083547.
[32]
LENG X, LEUNG T W. Collateral Flow in Intracranial Atherosclerotic Disease[J]. Transl Stroke Res, 2023, 14(1): 38-52. DOI: 10.1007/s12975-022-01042-3.
[33]
SONG X, ZHAO X, LIEBESKIND D S, et al. Incremental value of plaque enhancement in predicting stroke recurrence in symptomatic intracranial atherosclerosis[J]. Neuroradiology, 2020, 62(9): 1123-1131. DOI: 10.1007/s00234-020-02418-8.
[34]
HUANG L X, WU X B, LIU Y A, et al. Qualitative and quantitative plaque enhancement on high-resolution vessel wall imaging predicts symptomatic intracranial atherosclerotic stenosis[J/OL]. Brain Behav, 2023, 13(6): e3032 [2024-11-24]. https://pubmed.ncbi.nlm.nih.gov/37128149/. DOI: 10.1002/brb3.3032.
[35]
WU C H, CHUNG C P, CHEN T Y, et al. Influence of angioplasty and stenting on intracranial artery stenosis: preliminary results of high-resolution vessel wall imaging evaluation[J]. Eur Radiol, 2022, 32(10): 6788-6799. DOI: 10.1007/s00330-022-09010-z.
[36]
YANG D, LIU Y, HAN Y, et al. Signal of Carotid Intraplaque Hemorrhage on MR T1-Weighted Imaging: Association with Acute Cerebral Infarct[J]. AJNR Am J Neuroradiol, 2020, 41(5): 836-843. DOI: 10.3174/ajnr.A6498.
[37]
SCHINDLER A, SCHINNER R, ALTAF N, et al. Prediction of Stroke Risk by Detection of Hemorrhage in Carotid Plaques: Meta-Analysis of Individual Patient Data[J]. JACC Cardiovasc Imaging, 2020, 13(2Pt 1): 395-406. DOI: 10.1016/j.jcmg.2019.03.028.
[38]
YANG W J, FISHER M, ZHENG L, et al. Histological Characteristics of Intracranial Atherosclerosis in a Chinese Population: A Postmortem Study[J/OL]. Front Neurol, 2017, 8: 488 [2024-11-24]. https://pubmed.ncbi.nlm.nih.gov/28993752/. DOI: 10.3389/fneur.2017.00488.

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