Intracranial atherosclerosis disease (ICAD) can induce blood flow lateralization (BFL). However, the relationship of infarct patterns (IPs) with BFL was rarely explored. This study investigated the relationship between BFL and IPs in middle cerebral artery (MCA) using 4D flow MRI. Twenty-eight patients with unilateral MCA infarction were included. Average net flow (Flowavg) of infarction side and the contralateral side of MCA-M1 were compared in various IPs. Flowavg is significantly different between two sides of MCA in cortical infarct, but not significant in subcortical lesions. This suggests that cortical infarct may be the specific pattern for BFL in MCA.