Original article / research
Association of Vessel Wall MRI Findings with Clinical Outcomes in Atherosclerotic Ischaemic Stroke: A Systematic Review
OC06-OC10
Correspondence
Dr. Amrit Bansod,
Assistant Professor, Department of Neurology, Super Speciality Hospital and Government Medical College and Hospital, Nagpur-440003, Maharashtra, India.
E-mail: amritnamratabansod@gmail.com
Introduction: Vessel wall Magnetic Resonance Imaging (MRI) is a promising modality for identifying and characterising the atherosclerotic plaque and the vascular pathology. However, the prognostic value of vessel wall characteristics has not been established and is undefined.
Aim: To assess the association between plaque characteristics on vessel wall MRI with clinical outcomes in patients with ischaemic stroke.
Materials and Methods: The present systematic review was conducted at the Department of Neurology, Super Speciality Hospital and Government Medical College, Nagpur, and Datta Meghe Institute of Higher Education and Research,Wardha,Maharashtra,India between January 2026 and April 2026. The present systematic review was registered in Prospective Register of Systematic REviews (PROSPERO) (Reg no. CRD420261357174) and was conducted according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. Studies involving adult patients (>18 years) with atherosclerotic ischaemic stroke who underwent 3-Tesla vessel wall MRI were included. Prospective and retrospective cohort studies with more than 20 participants and full-text articles published in English from 2016 onwards were included, while case reports, case series, reviews, randomised controlled trials, and studies involving non atherosclerotic stroke aetiologies were excluded. A comprehensive literature search was performed in PubMed, Embase, ScienceDirect, Cochrane Library, and Google Scholar upto January 2026 using predefined MeSH terms and Boolean operators. A total of seven studies meeting the inclusion and exclusion criteria were included in the review including 766 patients. Risk of bias in included studies was assessed independently by two reviewers using the Newcastle Ottawa Scale (NOS), and the strength of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.
Results: The included studies were of high methodological quality; however, the certainty of evidence ranged from very low to moderate as per GRADE assessment due to observational nature of studies and heterogeneity in outcome definitions. The plaque characteristics included Intraplaque Haemorrhage (IPH), plaque enhancement and permeability, plaque burden and plaque composition showed significant association with poor functional outcomes. Plaque enhancement also independently predicted stroke recurrence (Hazard ratio: 2.17, 95% Confidence interval: 1.27-3.70). These were also associated with high National Institutes of Health Stroke Scale (NIHSS) score at admission.
Conclusion: Plaque characteristics on vessel wall MRI, particularly IPH and plaque enhancement, show consistent associations with adverse functional outcomes and recurrence of stroke. These findings suggest a potential role of vessel wall MRI in risk stratification and prognostic assessment in patients with ischaemic stroke; however, larger multicentric prospective studies are required to establish generalisability and prognostic utility.