Objective      To investigate the relationship of stroke risk with intra-plaque hemorrhage and wall remodeling in arteriosclerotic middle cerebral artery (MCA).       Methods      Clinical data of 127 adult patients with high-grade (≥70%) stenosis of MCA by three-dimensional time-of-flight (3D-TOF) magnetic resonance angiography (MRA) in our hospital from September 2012 to December 2014 were collected. Their high-resolution MRI (HR-MRI) findings were analyzed for the relationship of arterial wall remodeling model and intra-plaque hemorrhage with clinical events.        Results      A total of 130 high-grade stenotic MCA (54 symptomatic and 76 asymptomatic cases) were found in this cohort. There were 41 positive and 13 non-positive remodeling vessels in symptomatic MCA stenosis

and 18 positive and 58 non-positive remodeling vessels in asymptomatic MCA stenosis

with significant differences between the 2 groups (Chi square=34.76

P0.01). Intra-plaque hemorrhage (shown as high signal on T1-weighted fat-suppressed images

HST1) was found in 16 vessels (12.31%

13 symptomatic and 3 asymptomatic vessels). There were obvious difference in the occurrence of intra-plaque hemorrhage between the symptomatic and asymptomatic vessels (24.07% vs 3.95%

Chi square=11.85

P=0.001).       Conclusion      Positive remodeling and HST1 within MCA plaque on HR-MRI may increase with the risk of ipsilateral stroke.