Objective:To use whole brain vessel wall imaging combined with whole brain perfusion to explore the relevant high-risk features of imaging that caused the occurrence of ischemic stroke events.Method:A retrospective analysis was conducted on 60 patients with suspected atherosclerosis of middle cerebral artery(MCA)who admitted to The Second Affiliated Hospital of Bengbu Medical University from Oct.2021 to Mar.2023.All patients underwent the examination of high-resolution magnetic resonance vessel wall imaging(HRMR-VWI).According to the high signal values of diffusion weighted imaging(DWI),or the specifically clinical symptoms that were relevant with MCA blood-supplied area in clinical practice,they were divided into symptom group(36 cases)and non-symptom group(24 cases).The differences of the imaging characteristics of plaque,the status of collateral circulation and hemodynamic changes between the two groups were compared.The receiver operating characteristic(ROC)curve was drawn to appear the diagnostic efficiencies of the single factor model and the combined diagnostic model.Result:Compared with the non-symptom group,the patients of the symptom group had longer plaques,larger remodeling index,higher degree of plaque enhancement,more plaques located on the upper or posterior wall,more eccentric plaques,poorer status of collateral circulation,larger relative mean transit time(rMTT),larger relative time to peak(rTTP),and larger relative time to peak of residual function(rTmax).ROC curve analysis showed that the area under curve(AUC)values of the above four indicators were all lower than that of the combined diagnostic models of them(0.911).Conclusion:HRMR-VWI combined with compute tomography perfusion(CTP)can clarify the value of that in predicting ischemic events,and optimize the assessment system based on risk factors such as MCA atherosclerotic plaque,collateral status of leptomeningeal and cerebral perfusion status.