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Stroke Mechanism Subtypes and Prognosis in Patients With Symptomatic Intracranial Atherosclerosis Based on

Wenqiao Zheng1,2, Hua Wei2, Fan Bai2

  • 1Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, China.

Journal of Magnetic Resonance Imaging : JMRI
|May 16, 2025
PubMed
Abstract

Insights

Multiparametric MRI reveals distinct stroke mechanisms in intracranial atherosclerosis. Hypoperfusion is linked to a higher risk of recurrent stroke.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Medicine

Background:

  • Stroke mechanisms vary, influencing prognosis and secondary prevention strategies.
  • Multiparametric MRI offers detailed characterization of stroke subtypes.
  • Understanding these variations is crucial for effective patient management.

Purpose of the Study:

  • To investigate stroke mechanism subtypes in patients with symptomatic intracranial atherosclerosis.
  • To analyze the relationship between stroke mechanisms and prognosis using multiparametric MRI.
  • To identify imaging characteristics associated with different stroke mechanisms.

Main Methods:

  • Retrospective study of 217 ischemic stroke patients with intracranial atherosclerosis.
  • Utilized 3-T multiparametric MRI, including dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) and high-resolution vessel wall imaging (HR-VWI).
  • Assessed plaque characteristics, perfusion impairment (MTT-ASPECTS), and analyzed correlations with prognosis over 15 months.

Main Results:

  • Mixed mechanism was the most common subtype (32.7%).
  • Significant differences in perfusion, stenosis, plaque burden, and intraplaque hemorrhage (IPH) were observed across mechanisms.
  • MTT-ASPECTS and IPH were associated with non-branch occlusive disease (BOD) mechanisms. Hypoperfusion correlated with higher stroke recurrence risk.

Conclusions:

  • Multiparametric MRI effectively differentiates stroke mechanisms based on imaging characteristics.
  • Hypoperfusion mechanism is a significant predictor of increased stroke recurrence risk.
  • These findings support the role of advanced MRI in stroke subtyping and risk stratification.
Keywords:
dynamic susceptibility contrast perfusion‐weighted imaginghigh‐resolution vessel wall imagingintracranial atherosclerosismechanismprognosis

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