Neuroradiology · 2026
Association of middle cerebral artery atherosclerotic plaque with vessel tortuosity and white matter hyperintensity.
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Zheng Jinmei, Teng Yongqi, Xing Zhangli, Lin Lin, Hu Hanglin, Lin Mei, Zheng Enshuang, Sun Bin, Lin Ruolan, Xue Yunjing
Аннотация
PURPOSE: To investigate the association between middle cerebral artery (MCA) geometric parameters and atherosclerotic plaque, and the relationship between MCA plaque and white matter hyperintensity (WMH) burden.
METHODS: 157 patients suspected ischemic stroke or transient ischemic attack were enrolled. MCA geometry was measured on magnetic resonance angiography. MCA plaque was assessed using high-resolution magnetic resonance imaging. WMH was graded using the modified Fazekas scale. Generalized estimating equations were used to evaluate the association between MCA geometry and plaque. Logistic regression was performed to identify factors associated with moderate-to-severe WMH. Hemispheric WMH scores were compared in patients with unilateral MCA plaque.
RESULTS: 148 patients were analyzed. After adjusting for confounders, MCA main trunk tortuosity remained independently associated with the presence of MCA plaque (odds ratio (OR), 1.069; P = 0.017). The prevalence of MCA plaque was significantly higher in patients with moderate-to-severe WMH than in those with no-or-mild WMH ( P < 0.001). MCA plaque (OR = 2.926, P = 0.010) and stenosis severity (OR = 3.340, P < 0.001) were independently associated with moderate-to-severe WMH. The association was no longer significant after excluding patients with moderate-to-severe stenosis (OR = 1.761, P = 0.203). In patients with unilateral MCA plaque, WMH burden was significantly higher in the ipsilateral hemisphere than in the contralateral hemisphere (P = 0.006).
CONCLUSION: Greater MCA main trunk tortuosity is independently associated with the presence of MCA atherosclerotic plaque. MCA plaque is significantly associated with moderate-to-severe WMH, and this association is mainly driven by moderate-to-severe luminal stenosis. The ipsilateral predominance of WMH burden supports a local, territory-specific association rather than systemic atherosclerosis alone.
METHODS: 157 patients suspected ischemic stroke or transient ischemic attack were enrolled. MCA geometry was measured on magnetic resonance angiography. MCA plaque was assessed using high-resolution magnetic resonance imaging. WMH was graded using the modified Fazekas scale. Generalized estimating equations were used to evaluate the association between MCA geometry and plaque. Logistic regression was performed to identify factors associated with moderate-to-severe WMH. Hemispheric WMH scores were compared in patients with unilateral MCA plaque.
RESULTS: 148 patients were analyzed. After adjusting for confounders, MCA main trunk tortuosity remained independently associated with the presence of MCA plaque (odds ratio (OR), 1.069; P = 0.017). The prevalence of MCA plaque was significantly higher in patients with moderate-to-severe WMH than in those with no-or-mild WMH ( P < 0.001). MCA plaque (OR = 2.926, P = 0.010) and stenosis severity (OR = 3.340, P < 0.001) were independently associated with moderate-to-severe WMH. The association was no longer significant after excluding patients with moderate-to-severe stenosis (OR = 1.761, P = 0.203). In patients with unilateral MCA plaque, WMH burden was significantly higher in the ipsilateral hemisphere than in the contralateral hemisphere (P = 0.006).
CONCLUSION: Greater MCA main trunk tortuosity is independently associated with the presence of MCA atherosclerotic plaque. MCA plaque is significantly associated with moderate-to-severe WMH, and this association is mainly driven by moderate-to-severe luminal stenosis. The ipsilateral predominance of WMH burden supports a local, territory-specific association rather than systemic atherosclerosis alone.