Abstract
Previous studies have shown that lesions from recent small subcortical infarction (RSSI) with accompanying responsible vessel stenosis are closer to the openings of perforating branches and involve more slices on axial Magnetic Resonance Imaging (MRI). However, it remains unclear whether similar lesion characteristics are also associated with non-stenotic responsible vessel plaques that can be detected only by high-resolution MRI (HR-MRI). We enrolled consecutive patients with RSSI in the lenticulostriate artery (LSA) territory between January 2020 and December 2022. Patients with no visible stenosis in the ipsilateral middle cerebral artery (MCA) who completed HR-MRI were enrolled. Lesion characteristics including the lowest slice involved (LS), total number of slices involved (TNS) and maximal axial diameter (MAD) of RSSI lesions were evaluated by serialized axial levels of diffusion-weighted imaging (DWI). HR-MRI was used to assess the presence of dorsal superior plaques in the M1 segment of responsible MCA. Logistic regression analysis was performed to identify the lesion characteristics associated with the presence of dorsal superior plaques in the MCA. A receiver-operating characteristic (ROC) curve was employed to estimate the predictive efficacy of these parameters for MCA plaques using area under the ROC curve (AUC) and the optimal cut-off point. A total of 112 patients were included in the final analysis, with 57 (50.89%) having plaques detected on the dorsal superior wall of MCA. The average age of these patients was 57.08 years (57.08 ± 11.90 years), and 78 (69.64%) were male. Multivariate logistic regression showed that LS was significantly associated with MCA plaques (odds ratio [OR]: 0.674, 95% confidence interval [CI]: 0.485–0.937, p = 0.019). The optimal cut-off point (LS ≤ 1) was achieved by ROC curve analysis (AUC = 0.64, p = 0.007). The results indicate that in RSSI patients without responsible vascular stenosis, an LS ≤ 1 is significantly associated with the presence of dorsal superior plaques on the responsible vessel wall as detected by HR-MRI.