Vessel Wall MRI Over CTA Enhances Differentiation of Atherosclerotic vs Cardioembolic Stroke

Vessel wall MRI (VWI) significantly improved CTA discrimination between large-artery atherosclerotic and cardioembolic stroke: AUC 0.57 for CTA alone vs 0.76 with VWI in anterior circulation (p<0.001), and 0.77 vs 0.84 in posterior (p=0.02).

• In anterior circulation, intraplaque hemorrhage (IPH) had an adjusted odds ratio of 7.0 for LAA stroke (p<0.001), while noncalcified plaque extent and intracranial plaque enhancement were also independent predictors.
• In posterior circulation, IPE extent (aOR 2.2) and CTA plaque extent (aOR 5.9) were independent predictors, but IPH was not significantly associated.
• Retrospective design limits generalizability; findings support a pragmatic CTA-VWI workflow for etiologic characterization.

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