The images of middle cerebral artery contour submitted by Kato et al1 provide an example of a potentially useful innovative magnetic resonance technique for assessment of arterial wall morphology. The authors conclude that the enlarged vessel wall indicates dissection of the arterial wall and not arteriosclerotic disease.
Hemorrhage into an arteriosclerotic plaque in the arterial wall would also explain the magnetic resonance findings. How are we to distinguish plaque hemorrhage from dissection based on an expanded vascular wall containing blood products? The mechanism of stroke and treatment would not be the same for dissection and plaque hemorrhage.
Fellman D. Dissection or Hemorrhage Into Arteriosclerotic Plaque. Arch Neurol. 2011;68(6):830. doi:10.1001/archneurol.2011.115