Edge‐Type Hyperintense Intracranial Artery Plaque: A Potential MRI Biomarker of Stroke Recurrence

Background Identifying patients at high risk of stroke recurrence is important for stroke prevention and treatment. Purpose To explore the characteristics of T1 hyperintense plaques (HIP) and their relationship with stroke recurrence in patients with symptomatic intracranial atherosclerotic stenosis (sICAS). Study Type Retrospective. Population One hundred fifty‐seven patients with moderate‐to‐severe (≥50%) nonocclusive sICAS and MRI studies (42 females and 115 males, mean age 58.69 ± 10.68 years). Field Strength/Sequence 3D higher‐resolution black‐blood T1‐weighted fast‐spin‐echo sequence at 3.0 T. Assessment HIP (signal intensity [SI] of plaque‐to‐adjacent gray matter >1.0 on non‐contrast T1‐weighted images) and non‐HIP plaques were identified. HIP plaques were categorized as edge type (high SI adjacent to lumen) and non‐edge type (high SI within plaque). Clinical and imaging features of different plaque types were compared. Stroke recurrence was assessed through telephone or medical records at 3 and 6 months, and then once a year post‐MRI. The relationship between edge type and non‐edge types HIP with stroke recurrence was analyzed. Statistical Tests Student's t test, Mann–Whitney U ‐test, chi square test and Fisher's exact test to compare features between plaque types. Kaplan–Meier curves (with log‐rank tests) and Cox proportional hazards regression to assess relationship between stroke recurrence and different plaque types. A two‐tailed P ‐value of <0.05 was considered statistically significant. Results Of 157 culprit lesions, 87 (55%) were HIPs (43 edge type, 44 non‐edge type) and 70 (45%) were non‐HIPs. Plaque thickness, area, and volume were significantly higher for HIPs than for non‐HIPs. Among patients with HIPs, edge type was significantly more likely in the posterior circulation (53.5% vs. 27.3%), and had significantly higher plaque thickness, length, area, volume, plaque burden, and remodeling index than non‐edge type. Edge‐type HIP was significantly more common than non‐edge HIP in patients with diabetes mellitus (51.2% vs. 29.5%) and dyslipidemia (79.1% vs. 54.5%). During median follow‐up of 27 months, 33 patients experienced stroke recurrence. Recurrence was associated with edge‐type HIP (adjusted hazard ratio = 2.83; 95% confidence interval: 1.40–5.69), both in the overall cohort (34.9% vs. 15.8%) and in patients with HIP (34.9% vs. 9.0%). Age ≥60 years and edge‐type HIP had a significant interaction. Data Conclusions Hyperintense plaque may be categorized as edge type or non‐edge type. Edge‐type HIP may be a potential MRI biomarker of stroke recurrence. Evidence Level 3 Technical Efficacy Stage 2