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November 12, 2026Frontiers in NeurologyOpen Access

High-resolution vessel wall MRI and computational fluid dynamics for characterizing plaque-associated hemodynamics in middle cerebral artery atherosclerotic stenosis

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Why the study?

The association between middle cerebral artery plaque distribution and wall shear stress, as well as the relationship between plaque characteristics and watershed infarction subtypes, required investigation.

Is middle cerebral artery plaque spatial distribution and morphology on high-resolution vessel wall MRI associated with wall shear stress and specific watershed infarction patterns (internal vs. cortical borderzone infarction) in patients with symptomatic MCA-M1 stenosis?

Key Points

To assess the relationship between middle cerebral artery (MCA) plaque distribution and wall shear stress, and to evaluate how plaque characteristics correlate with watershed infarction patterns.
Retrospectively analyzed 50 patients with symptomatic atherosclerotic MCA-M1 stenosis (50–99%) and watershed infarction who underwent 3.0T HR-VWI between January 2025 and December 2025.
Classified infarct patterns into internal borderzone infarction (IBZ, n = 26), cortical borderzone infarction (CBZ, n = 18), and mixed IBZ + CBZ (n = 6).
Identified plaque distribution across four quadrants (superior, inferior, ventral, dorsal) using HR-VWI and constructed computational fluid dynamics models to quantify wall shear stress (WSS) and wall shear stress ratio (WSSR).
Among 50 identified plaques, 21 were located on the inferior wall, 13 on the superior wall, 11 on the ventral wall, and 5 on the dorsal wall; differences across locations were not statistically significant for WSS (p = 0.247) or WSSR (p = 0.139).
Plaque location was significantly associated with infarct patterns (p < 0.05), with inferior wall plaques associated with IBZ and superior wall plaques associated with CBZ.
Shorter plaque length was significantly more frequent in patients with CBZ compared to other patterns (p < 0.05).

Study Design

Type

Cohort (n=50)

Blinding

Both radiologist readers were blinded to the patients' infarction patterns and clinical group assignments during image assessment

Multicenter

No

Structured PICO

Is middle cerebral artery plaque spatial distribution and morphology on high-resolution vessel wall MRI associated with wall shear stress and specific watershed infarction patterns (internal vs. cortical borderzone infarction) in patients with symptomatic MCA-M1 stenosis?

P

Population

50 adults in China with symptomatic atherosclerotic MCA-M1 stenosis (50-99%) and borderzone infarction within the previous 6 months (median age 59 years, 64% male).

E

Exposure

High-resolution vessel wall MRI (HR-VWI) characterization of MCA-M1 plaque spatial distribution (superior, inferior, ventral, and dorsal walls) and morphology (area, length, thickness) integrated with 3D computational fluid dynamics (CFD) modeling.

C

Comparator

Comparison across the four arterial wall quadrants (superior [n=13], inferior [n=21], ventral [n=11], dorsal [n=5]) and between watershed infarction subtypes (IBZ vs. CBZ).

O

Outcome

Association between MCA plaque spatial distribution/morphology and watershed infarction subtypes (internal borderzone [IBZ] vs. cortical borderzone [CBZ] infarction), and plaque-associated local hemodynamics (wall shear stress [WSS] and wall shear stress ratio [WSSR]).hard clinical

Main Result

Effect estimate: Cramér's V 0.539 (95% CI 0.170-0.800)

Absolute Event Rate: 53.85% vs 22.22%

p-value: p=0.004

Limitations

Relatively small sample size (n=50) and limited number of plaques in some anatomical categories, particularly the dorsal-wall group
Substantial interindividual variation in vascular geometry and flow conditions
No independent experimental or clinical data were used for external validation of the CFD model
Cerebral perfusion, collateral circulation, and embolic events were not directly assessed
Histological features of plaque vulnerability (lipid core, fibrous cap thickness, intraplaque hemorrhage, or plaque rupture) were not directly assessed
Relatively small sample size (n=50) and limited number of plaques in some anatomical categories, particularly the dorsal-wall group (n=5)
No independent experimental or clinical data were used for external validation of the CFD model (assumed rigid arterial walls, Newtonian laminar flow, and population-averaged inlet velocity)
Plaque vulnerability features such as lipid core, fibrous cap thickness, intraplaque hemorrhage, or plaque rupture were not directly assessed

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

In patients with symptomatic MCA-M1 stenosis, HR-VWI demonstrates that inferior wall plaques are associated with internal borderzone infarcts and superior wall and shorter plaques with cortical borderzone infarcts, whereas CFD-derived wall shear stress does not significantly differ by plaque location.

Abstract

Objective This study investigated the association between middle cerebral artery (MCA) plaque distribution and wall shear stress (WSS) and examined the relationship between plaque characteristics and watershed infarction subtypes. Methods We conducted a retrospective study of 50 patients with atherosclerotic MCA-M1 stenosis (50–99%) and watershed infarction. Based on infarct patterns, patients were classified into three groups: internal borderzone infarction (IBZ, n = 26), cortical borderzone infarction (CBZ, n = 18), and mixed IBZ + CBZ infarction ( n = 6). Plaque characteristics, including distribution, area, length, and thickness, were assessed using high-resolution vessel wall imaging (HR-VWI), and computational fluid dynamics (CFD) models were established based on HR-VWI to obtain WSS. Results A total of 50 plaques were identified in the 50 patients, including 13 on the superior wall, 21 on the inferior wall, 11 on the ventral wall, and 5 on the dorsal wall. Although superior wall plaques showed the highest mean WSS and inferior wall plaques showed the lowest, the differences in WSS or wall shear stress ratio (WSSR) among plaque locations were not statistically significant ( p = 0.247 and p = 0.139, respectively). Plaque location was significantly associated with infarct patterns ( p < 0.05): inferior wall plaques were associated with IBZ, whereas superior wall plaques were associated with CBZ. Shorter plaques were also more frequently observed in patients with CBZ ( p < 0.05). Conclusion These findings suggest that plaque distribution is associated with different watershed infarction patterns, whereas plaque location is not significantly associated with WSS or WSSR. Integrating quantitative plaque characteristics derived from HR-VWI with CFD-based hemodynamic analysis may provide additional insights into the mechanisms underlying different watershed infarction patterns in patients with symptomatic MCA-M1 atherosclerotic stenosis.

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Cite This Study

Chen et al. (2026) conducted a cohort in Symptomatic atherosclerotic middle cerebral artery (MCA-M1) stenosis (50-99%) with watershed infarction (n=50). Middle cerebral artery plaque spatial distribution (superior, inferior, ventral, dorsal walls) assessed by HR-VWI and CFD vs. Across the four arterial wall quadrants (superior, inferior, ventral, dorsal) and between isolated IBZ and CBZ infarction groups was evaluated on Watershed infarction pattern (isolated internal borderzone [IBZ] vs. isolated cortical borderzone [CBZ] infarction) (Cramér's V 0.539, 95% CI 0.170-0.800, p=0.004).

synapsesocial.com/papers/6af73ada9badce7b6084db62 https://doi.org/10.3389/fneur.2026.1994351

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