Middle cerebral artery intraplaque hemorrhage: prevalence and clinical relevance

Ann Neurol. 2012 Feb;71(2):195-8. doi: 10.1002/ana.22626.


Objective: Little is known about the composition of middle cerebral artery (MCA) plaques and how they relate to clinical status. Using high-resolution magnetic resonance imaging (HR-MRI), we aimed to examine the occurrence of high signal on T1-weighted fat-suppressed images (HST1) of MCA plaques, which are highly suggestive of fresh or recent intraplaque hemorrhage.

Methods: We retrospectively analyzed the HR-MRI and clinical data of 107 adult patients with high-grade (>70%) MCA stenosis. On HR-MRI, HST1 within an MCA plaque was defined as an area with an intensity >150% of the signal of adjacent muscles. The relationship between HST1 and clinical presentations was analyzed.

Results: A total of 109 stenotic MCAs (46 symptomatic and 63 asymptomatic) on 981 image slices were analyzed. HST1 was revealed on HR-MRI in 11 vessels (10.1%, 9 symptomatic and 2 asymptomatic). The occurrence rate of HST1 between symptomatic and asymptomatic MCAs was significantly different (19.6% vs 3.2%, p = 0.01).

Interpretation: HST1 within MCA plaque on HR-MRI is associated with ipsilateral stroke. Our results provide new insight into the vascular biology of MCA atherosclerosis.

MeSH terms

  • Constriction, Pathologic / epidemiology
  • Constriction, Pathologic / pathology*
  • Hemorrhage / epidemiology*
  • Hemorrhage / pathology*
  • Humans
  • Magnetic Resonance Imaging
  • Middle Aged
  • Middle Cerebral Artery / pathology*
  • Plaque, Atherosclerotic / epidemiology
  • Plaque, Atherosclerotic / pathology*
  • Prevalence
  • Retrospective Studies
  • Severity of Illness Index