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Patients with basilar artery stenosis (n=126; 66 symptomatic and 60 asymptomatic) underwent high-resolution MR imaging. The relationship between imaging findings (intraplaque hemorrhage, contrast enhancement, degree of stenosis, minimal lumen area, and plaque burden) and symptoms was analyzed. Intraplaque hemorrhage was identified in 22 patients (17.5%), including 21 (31.8%) symptomatic patients and 1 (1.7%) asymptomatic patient. Multivariate analysis showed that intraplaque hemorrhage was the strongest independent marker of symptomatic status. Contrast enhancement was also independently associated with symptomatic status. The authors conclude that intraplaque hemorrhage is present in both low- and high-grade stenotic basilar artery plaques and is independently associated with symptomatic stroke status. Intraplaque hemorrhage may identify high-risk plaque and provide new insight into the management of patients with stroke without significant stenosis.

MR imaging–pathologic studies have reported that paramagnetic rims on 7T susceptibility-based MR imaging identify, in vivo, a subset of MS lesions with compartmentalized inflammation at the lesion edge and associated remyelination failure. High-resolution T2* and phase MR imaging were collected in 20 patients with MS at 3T and 7T. Phase rims were seen in 34 lesions at 7T and in 36 lesions at 3T by consensus. Inter- and intra-rater reliability were “substantial/good” both at 3T and 7T analysis. Nearly all 7T paramagnetic rims can also be seen at 3T. Imaging at 3T opens the possibility of implementing paramagnetic rims as an outcome measure.