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• Clinical Article •
A comparative study of plaque and circle of Willis anatomical characteristics between first-episode and recurrent anterior circulation ischemic stroke patients based on HR-MR-VWI
WANG Zehua  HE Jinlong  GAO Yang  HAO Xiangcheng 

Cite this article as: WANG Z H, HE J L, GAO Y, et al. A comparative study of plaque and circle of Willis anatomical characteristics between first-episode and recurrent anterior circulation ischemic stroke patients based on HR-MR-VWI[J]. Chin J Magn Reson Imaging, 2026, 17(9): 110-117, 128. DOI:10.12015/issn.1674-8034.2026.09.015.


[Abstract] Objective To investigate the predictive value of plaque features combined with the integrity of the circle of Willis for recurrent stroke and the correlation between the integrity of the circle of Willis and plaque features.Materials and Methods A total of 85 patients with symptomatic intracranial atherosclerotic stenosis were enrolled retrospectively. All patients underwent high-resolution magnetic resonance vessel wall imaging within 14 days after symptom onset, and were divided into an initial stroke group and a recurrent stroke group according to clinical and imaging data. The two groups were compared in terms of the integrity of the circle of Willis, characteristics of intracranial responsible plaques, plaque number, and plaque coexistence. Multivariate logistic regression analysis was performed to identify independent imaging markers correlated with recurrent stroke history. Binary logistic regression analysis was adopted to assess the correlation between the integrity of the circle of Willis and the characteristics of intracranial vulnerable plaques.Results Compared with the initial stroke group, the recurrent stroke group had a higher degree of responsible vessel stenosis (t = -2.367, P = 0.020), a larger total number of plaques (Z = -4.401, P = 0.001), and higher incidence rates of irregular plaque surface (χ2 = 6.953, P = 0.008), incomplete symptomatic posterior circle of Willis (χ2 = 11.318, P = 0.001) and plaque coexistence (χ2 = 7.063, P = 0.008); multivariate logistic regression analysis showed that the total number of plaques (OR = 2.101, 95% CI: 1.109 to 3.976, P = 0.023) and incomplete symptomatic posterior circle of Willis (OR = 2.984, 95% CI: 1.021 to 9.041, P = 0.045) were independently associated with history of recurrent ischemic stroke. The combined logistic regression model exhibited the optimal predictive performance. Its area under the curve (AUC) was significantly higher than that of the single predictor of incomplete symptomatic posterior segment of the circle of Willis, while no statistically significant difference in predictive efficacy was observed between the combined model and the single predictor of total plaque number. Univariate logistic regression analysis showed that incomplete anterior circle of Willis was independently correlated with irregular plaque surface (OR = 6.522, 95% CI: 2.381 to 17.836, P = 0.001), and incomplete symptomatic posterior circle of Willis was also independently correlated with irregular plaque surface (OR = 3.373, 95% CI: 1.266 to 8.942, P = 0.015). After adjusting for age, gender and clinical risk factors including smoking history, drinking history, hyperlipidemia, hypertension and diabetes, multivariate logistic regression analysis further revealed that incomplete anterior circle of Willis was independently associated with irregular plaque surface (OR = 6.741, 95% CI: 2.390 to 19.023, P = 0.001), and incomplete symptomatic posterior circle of Willis remained independently correlated with irregular plaque surface (OR = 3.420, 95% CI: 1.249 to 9.355, P = 0.017).Conclusions Increased plaque number and ipsilateral posterior circulation defects of the circle of Willis were more common in patients with anterior circulation ischemic stroke and a history of recurrent stroke. Both incomplete anterior circle of Willis and incomplete symptomatic posterior circle of Willis are independently correlated with irregular plaque surface. Integrated cranio-cervical high-resolution magnetic resonance vessel wall imaging allows direct visualization and comparison of plaque features and anatomical configurations of the circle of Willis between patients with first-ever and recurrent stroke, and provides imaging evidence for stroke risk stratification.
[Keywords] stroke；recurrence；intracranial atherosclerosis；high-resolution magnetic resonance vessel wall imaging；magnetic resonance imaging；plaques；circle of Willis

WANG Zehua   HE Jinlong*   GAO Yang   HAO Xiangcheng  

Department of Radiology, the First Clinical Medical College of Inner Mongolia Medical University, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China

Corresponding author: HE J L, E-mail: yxytxy@163.com

Conflicts of interest   None.

Received  2026-05-25
Accepted  2026-08-20
DOI: 10.12015/issn.1674-8034.2026.09.015
Cite this article as: WANG Z H, HE J L, GAO Y, et al. A comparative study of plaque and circle of Willis anatomical characteristics between first-episode and recurrent anterior circulation ischemic stroke patients based on HR-MR-VWI[J]. Chin J Magn Reson Imaging, 2026, 17(9): 110-117, 128. DOI:10.12015/issn.1674-8034.2026.09.015.

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