Regression of Plaque Enhancement Within Symptomatic Middle Cerebral Artery Atherosclerosis: A High-Resolution MRI Study

Wen Jie Yang, Jill Abrigo, Yannie Oi Yan Soo, Simon Wong, Ka Sing Wong, Thomas Wai Hong Leung, Winnie Chiu Wing Chu, Xiang Yan Chen

Research output: Journal article publicationJournal articleAcademic researchpeer-review

26 Citations (Scopus)


Objective: Contrast enhancement is a vital feature of the intracranial atherosclerotic plaque on high-resolution magnetic resonance imaging (HRMRI), but its clinical significance is still unclear. We aimed to quantitatively assess plaque enhancement patterns in the middle cerebral artery (MCA) atherosclerotic plaque. Methods: We conducted a cross-sectional study by prospectively recruiting stroke or transient ischemic attack patients with >30% of MCA stenosis of either side. All patients underwent contrast-enhanced HRMRI scans. Enrolled patients were classified into acute phase (<4 weeks), subacute phase (4–12 weeks) and chronic phase (>12 weeks) groups based on the time interval from stroke onset to imaging scan. Plaque enhancement index was calculated for each MCA lesion at the maximal narrowing site. Results: We identified a total of 89 MCA plaques [53 (60%) symptomatic and 36 (40%) asymptomatic; 57 (64%) acute, 18 (20%) subacute and 14 (16%) chronic] in 58 patients on HRMRI. Among the acute lesions, symptomatic plaques had a significantly stronger plaque enhancement than asymptomatic plaques (symptomatic vs. asymptomatic: 38.9 ± 18.2 vs. 18.2 ± 16.2, p < 0.001). Among the symptomatic lesions, plaque enhancement diminished with increasing time after stroke onset (38.9 ± 18.2, 22.0 ± 22.8, and 5.0 ± 10.1 for acute, subacute, and chronic phase, respectively; p = 0.001). Conclusion: Plaque enhancement in the acute atherosclerotic plaque is closely related to recent ischemic events. In symptomatic atherosclerosis, plaque enhancement regresses over time after ischemic stroke, which may offer the potential to monitor the plaque activity in intracranial atherosclerosis using HRMRI.

Original languageEnglish
Article number755
JournalFrontiers in Neurology
Publication statusPublished - 28 Jul 2020


  • inflammation
  • intracranial atherosclerosis
  • magnetic resonance imaging
  • middle cerebral artery
  • plaque enhancement
  • stroke

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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