This study aims to evaluate the role of <50% stenotic cervical carotid artery plaques in embolic stroke of undetermined source (ESUS), focusing on plaque characteristics in symptomatic versus asymptomatic carotid arteries (contralateral). In this cross-sectional observational study, 81 patients who met the diagnostic criteria for ESUS and underwent were retrospectively analyzed. Carotid plaques causing <50% stenosis were examined, noting features such as plaque thickness, degree of luminal stenosis, irregularity, ulceration, calcification, and hypodensity. These characteristics were compared between the ipsilateral and contralateral carotid arteries. The study involved 33 men and 48 women, with plaques ≥3mm thick significantly more common in the ipsilateral carotid arteries (P < .05). Notable features such as plaque ulceration, irregularity, noncalcified plaque, and hypodensity were significantly more frequent ipsilaterally (P < .05). Of the plaque patients, 54.3% (44/81) were on the ipsilateral side, compared to 29.6% (24/81) on the contralateral side (P = .0024). Our findings underscore the potential significance of non-stenotic carotid plaques in ESUS. These plaques, especially those with certain high-risk characteristics, are more prevalent ipsilaterally and should be considered in clinical evaluations and treatment of ESUS.

Objectives: To assess the additional diagnostic value of fetal magnetic resonance imaging (MRI) compared to prenatal ultrasonography (US) in fetal anomaly evaluation, using postnatal confirmation as the reference standard. Methods: In this retrospective cross-sectional study, we evaluated 104 fetal cases who underwent fetal MRI following suspicious or abnormal second- or third-trimester US findings between January 2022 and January 2025. US and MRI findings were compared, and diagnostic concordance was categorized. Postnatal confirmation was based on imaging, surgical, clinical, or pathological follow-up. Diagnostic accuracy rates were calculated using postnatal outcomes as the gold standard, and modality agreement was assessed using the kappa coefficient and McNemar test. Results: Postnatal confirmation data were available for 99 of the 104 cases, comprising 149 anomalies. MRI and US showed complete agreement in 79.8 % of cases. MRI provided additional diagnostic information over US in 10.6 % and showed discrepant findings in 9.6 %. Postnatal data confirmed that US correctly diagnosed 76.8 % of cases, while MRI reached 92.9 % diagnostic accuracy, a statistically significant difference (p=0.0015). The agreement between modalities was moderate (κ=0.54). MRI notably enhanced diagnostic accuracy, especially for central nervous system anomalies, and influenced postnatal clinical management. Conclusions: Fetal MRI significantly improves prenatal diagnostic accuracy over US, particularly in complex or ambiguous cases, with the most significant added value seen in central nervous system pathologies. Its complementary role enhances prenatal counseling and postnatal planning. Larger multicenter studies are warranted to evaluate its contribution across different organ systems.