Higher-grade HR-MRI plaque enhancement independently predicts recurrent ischemic events in mild-to-moderate intracranial arterial stenosis and provides incremental risk stratification beyond stenosis rate.
Recurrence-free survival differed significantly by plaque enhancement grade in patients with mild-to-moderate intracranial atherosclerotic stenosis.
Grade 2 plaque enhancement was associated with significantly higher recurrence risk compared to grade 0.
Each one-grade increase in plaque enhancement was associated with incrementally higher recurrence risk.
Grade 2 plaque enhancement remained associated with higher risk for stroke recurrence specifically.
HR-MRI plaque enhancement grading provided incremental risk stratification value beyond stenosis rate alone in mild-to-moderate intracranial arterial stenosis.
The study enrolled 381 patients with ischemic stroke or TIA attributed to mild-to-moderate intracranial arterial stenosis who underwent contrast-enhanced HR-MRI within 14 days of onset.
This research suggests that the degree to which arterial plaques 'light up' on specialized MRI scans can predict the risk of future strokes or mini-strokes (TIAs) in patients who have mild-to-moderate narrowing of arteries inside the brain. The study followed 381 patients who had already experienced a stroke or TIA and had artery narrowing between 30-69% — a range previously considered difficult to risk-stratify using artery narrowing alone. By grading how much the plaque enhanced (brightened) on contrast MRI scans on a scale of 0 to 2, researchers found that patients with the highest grade of enhancement (grade 2) were more than twice as likely to have a recurrent stroke or TIA compared to those with no enhancement (grade 0), even after accounting for the degree of narrowing, LDL cholesterol, and age. Importantly, the risk appeared to increase in a stepwise fashion with each grade increase, and the association held true even when looking specifically at stroke recurrence. About 1 in 7 patients (13.65%) experienced a recurrent ischemic event, with the median time to recurrence being roughly 171 days. This suggests that plaque enhancement on high-resolution MRI captures something about plaque 'activity' or instability that the degree of artery narrowing alone does not reveal. This research suggests that adding plaque enhancement grading to standard imaging assessments could help clinicians identify which patients with mild-to-moderate intracranial artery disease are at higher risk of having another stroke, potentially allowing for more intensive monitoring and more aggressive risk factor management in those patients. The findings highlight that even patients with less severe artery narrowing may carry significant stroke risk if their plaques show high enhancement on MRI.
Zhou X, Wei H. (2026). Plaque Enhancement Grade on High-Resolution MRI and Recurrent Ischemic Events in Intracranial Stenosis: A Retrospective Cohort Study.. Journal of visualized experiments : JoVE. https://doi.org/10.3791/71162