associations of high intensities on magnetizationprepared rapid acquisition with gradient echo with aortic complicated lesions in ischemic stroke patients background aortic complicated lesions acls are key parameters for evaluating aortic embolic sources in embolic stroke and are usually diagnosed using transesophageal echocardiography tee however alternative methods for diagnosing acls have not been well established we investigated associations between highintensity areas on t1weighted imaging t1wi with magnetizationprepared rapid acquisition with gradient echo mprage and acls on tee among ischemic stroke patientsmethods participants comprised 135 patients mean age 71 years 35 women with ischemic stroke or transient ischemic attack who underwent tee for evaluation of embolic sources and plaque imaging using mprage for evaluation of aortic or carotid plaques aortic plaque with signal intensity 200 of sternocleidomastoid intensity on mprage was categorized as high intensity acls on tee were defined by focal increases in intimamedia thickness imt 40 mm or the presence of ulcerated or mobile plaquesresults fiftysix patients 42 showed highintensity areas on mprage at the aortic arch aortic maximum imt was significantly higher in patients with high intensities than in those without p 0001 incidences of acls 66 vs 20 p 0001 or ulcerated or mobile plaques 30 vs 6 p 0001 were significantly higher in patients with high intensities than in patients without multivariable logistic regression analysis showed that high intensities on mprage were independently associated with the presence of acls or 572 95 ci 2381370 and ulcerated or mobile plaques or 418 95 ci 1291350conclusions high intensities on t1wi with mprage in the aortic arch were significantly associated with the presence of acls an evaluation of the aortic arch using mprage may be useful for predicting acls