Diagnosis of deep subcortical infarcts based on atherosclerosis of the middle cerebral artery (MCA) is important because this type of infarct is usually more aggressive than typical lacunar infarcts. However, current imaging techniques are of limited utility in the diagnosis of MCA plaques. Here, we report the use of 3-Tesla (3T) high-resolution moderate T2-weighted imaging (HRT2WI) to detect MCA plaques in three patients with acute MCA perforator territory infarcts. MCA plaques were seen with HRT2WI in a patient with MCA stenosis, which was observed by magnetic resonance angiography (MRA). Of the two patients without MCA stenosis (also confirmed by MRA), one had thin MCA plaques and the other had normal walls based on HRT2WI. Progression of symptoms occurred in the patients with plaques. We conclude that 3T HRT2WI can identify plaque on MCA walls and has the potential to identify patients at risk for stroke progression or recurrence.