Intracranial Artery Atherosclerosis and Lumen Dilation in Cerebral Small-Vessel Diseases: A High-resolution MRI Study

Background and Aims Using high-resolution magnetic resonance imaging (HR-MRI), we aimed to investigate the abnormalities of intracranial artery in relation to cerebral small-vessel diseases (SVD)-related ischemic stroke and white matter lesions (WMLs). Methods Routine cranial MRI and HR-MRI were performed on consecutive patients with a SVD-related acute deep brain infarct (DBI) in the territory of middle cerebral artery (MCA), patients with SVD-related WMLs, and age-matched controls. The presence and distribution of MCA plaque and the area of MCA lumen and wall were comparatively analyzed among the groups. Results A total of 2340 image slices of 260 vessels in 130 subjects (57 with an acute DBI, 28 with WMLs, and 45 control subjects) were analyzed. In the patients with a DBI, eccentric plaques were identified in 26 vessels ipsilateral and 24 vessels contralateral to the ischemic lesions. Superior-wall plaques of MCA were observed more frequently ipsilateral than contralateral to the infarcts (69.2% vs. 37.5%, P=0.025). Compared to the controls, larger outer-wall boundary area (P <= 0.017) and wall area (P<0.001) were observed in the patients, while larger lumen was only observed in the WMLs group (P<0.001). Conclusions Middle cerebral artery superior-wall plaques are associated with acute DBIs, while MCA lumen dilation is associated with WMLs.