ArticleQuantitative imaging in medicine and surgery2026
Association of intracranial plaque characteristics and cerebral small vessel disease burden with acute ischemic stroke in patients with intracranial atherosclerotic disease.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Both intracranial atherosclerotic disease (ICAD) and cerebral small-vessel disease (CSVD) contribute to ischemic stroke and have shared underlying pathophysiological mechanisms. Thus, the aim of this study was to investigate the value of intracranial plaque and CSVD imaging characteristics in diagnosing ischemic stroke and to clarify the impact of coexisting large and small intracranial vessel disease on stroke risk. Methods: Patients with ICAD who underwent contrast-enhanced higher-resolution vessel wall magnetic resonance imaging (HRVW-MRI) from January 2021 to April 2024 were enrolled. Plaque features such as intraplaque hemorrhage (IPH), enhancement grade, maximum wall thickness (Max WT), and lumen area (LA) were assessed via HRVW-MRI. A CSVD score was determined through four CSVD imaging markers, including lacunes, white-matter lesions (WMLs), cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVSs), with the possible score ranging from 0 to 4. Binary logistic regression analysis was used to ascertain the associations between imaging characteristics and stroke events. The diagnostic performance of imaging indicators was evaluated via receiver operating characteristic (ROC) curves. Results: Of the 237 patients (median age 63 years; 154 males) enrolled in the study, 174 experienced stroke. Binary logistic regression revealed that patients with greater Max WT, larger LA, a higher number of CMBs and EPVSs, higher enhancement grade, and higher total CSVD score were more likely to experience stroke (all P values <0.05). Enhancement grade remained a robust independent predictor of stroke across all the examined imaging characteristics (odds ratio =6.56-8.96; P<0.001). The two diagnostic models derived from the combination of plaque and CSVD imaging features yielded a higher area under the curve (0.839; 95% CI: 0.783-0.895; P<0.001; 0.787; 95% CI: 0.722-0.851; P<0.001) than did that of the plaque features alone (0.774; 95% CI: 0.709-0.839; P<0.001). Conclusions: The combination of plaque features with CSVD imaging markers provides incremental value for diagnosing stroke occurrence and may aid in the clinical management of high-risk patients.
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