Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial-resolution MR images

Radiology. 2014 May;271(2):534-42. doi: 10.1148/radiol.13122812. Epub 2014 Jan 16.


Purpose: To characterize intracranial plaque inflammation in vivo by using three-dimensional (3D) high-spatial-resolution contrast material-enhanced black-blood (BB) magnetic resonance (MR) imaging and to investigate the relationship between intracranial plaque inflammation and cerebrovascular ischemic events.

Materials and methods: The study was approved by the institutional review board and was HIPAA compliant. Twenty-seven patients (19 men; mean age, 56.8 years ± 12.4 [standard deviation]) with cerebrovascular ischemic events (acute stroke, n = 20; subacute stroke, n = 2; chronic stroke, n = 3; transient ischemic attack, n = 2) underwent 3D time-of-flight MR angiography and contrast-enhanced BB 3-T MR imaging for intracranial atherosclerotic disease. Each identified plaque was classified as either culprit (the only or most stenotic lesion upstream from a stroke), probably culprit (not the most stenotic lesion upstream from a stroke), or nonculprit (not within the vascular territory of a stroke). Plaque contrast enhancement was categorized on BB MR images (grade 0, enhancement less than or equal to that of normal arterial walls seen elsewhere; grade 1, enhancement greater than grade 0 but less than that of the pituitary infundibulum; grade 2, enhancement greater than or equal to that of the pituitary infundibulum), and degree of contrast enhancement was calculated. Associations of the likelihood of being a culprit lesion with both plaque contrast enhancement and plaque thickness were estimated with ordinal logistic regression.

Results: Seventy-eight plaques were identified in 20 patients with acute stroke (21 [27%] culprit, 12 [15%] probably culprit, and 45 [58%] nonculprit plaques). In these patients, grade 2 contrast enhancement was associated with culprit plaques (odds ratio 34.6; 95% confidence interval: 4.5, 266.5 compared with grade 0) when adjusted for plaque thickness. Grade 0 was observed in only nonculprit plaques. Culprit plaques had a higher degree of contrast enhancement than did nonculprit plaques (25.9% ± 13.4 vs 13.6% ± 12.3, P = .003).

Conclusion: Contrast enhancement of intracranial atherosclerotic plaque is associated with its likelihood to have caused a recent ischemic event and may serve as a marker of its stability, thereby providing important insight into stroke risk.

MeSH terms

  • Brain Ischemia / etiology*
  • Brain Ischemia / pathology*
  • Contrast Media
  • Gadolinium DTPA
  • Humans
  • Image Enhancement / methods*
  • Image Interpretation, Computer-Assisted
  • Imaging, Three-Dimensional
  • Magnetic Resonance Angiography / methods
  • Middle Aged
  • Plaque, Atherosclerotic / complications*
  • Plaque, Atherosclerotic / pathology*
  • Prospective Studies
  • Reproducibility of Results
  • Risk Factors
  • Stroke / etiology*
  • Stroke / pathology*


  • Contrast Media
  • Gadolinium DTPA