FIGURE.

Representative case with conventional stroke work-up with negative findings and altered etiologic classification after VW-MR imaging. Diffusion-weighted MR imaging (A) shows an acute infarct in the left MCA lenticulostriate territory. MRA anterior-posterior (B) and craniocaudal (C) projections show no/minimal narrowing of the left MCA (arrows). Sagittal T2-weighted VW-MR imaging (D) shows a cross-section through the left MCA (dashed arrow), and a magnified view (inset box) shows focal, eccentric, thickening of the superior-posterior wall of the left MCA (solid arrows). Sagittal contrast-enhanced T1-weighted VW-MR imaging (E) shows the same vessel (dashed arrow) with corresponding wall enhancement (solid arrow). The VW-MR imaging appearance is consistent with atherosclerotic plaque, and the enhancement is a finding more common in recently symptomatic plaque. Adapted with permission from Schaafsma et al.²³