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Updated: Jun 3, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Reduced rCBV ratio in perfusion-weighted MR images predicts poor outcome after thrombolysis in acute ischemic stroke
Hyang-I Park1, Jae-Kwan Cha, Myung-Jin Kang
1Department of Neurology, Busan-Ulsan Regional Cardio-Cerebrovascular Diseases Center, Chang-Won Samsung Medical Center, Dong-A University Hospital, Republic of Korea.
Abstract:
Recent research has suggested that a perfusion-weighted image (PWI) relative cerebral blood volume (rCBV) map after acute ischemic stroke (AIS) provides information about the collateral circulation in the ischemic region. In this study, we demonstrate the usefulness of the rCBV ratio in PWI in predicting poor outcome after using IV t-PA in AIS. We recruited 58 stroke patients who were treated with IV t-PA after diagnostic magnetic resonance imaging (MRI). Poor outcome was defined as a Modified Rankin Scale (mRS) score >2 measured 90 days after ischemic insult. In total, 21 patients (36.2%) demonstrated poor outcome (i.e. mRS score 3-6). Poor outcome after t-PA correlated with age (p = 0.03), serum glucose level (p = 0.01), NIHSS (p = 0.05), and the presence of T-occlusion (p = 0.05). Poor outcome also correlated with diffusion-weighted MR images of the lesion volume (p < 0.01), lower rCBV ratio on PWI (p < 0.01), and non-recanalization (p < 0.01). Among these, non-recanalization (p < 0.01), reduced rCBV ratio on PWI (p < 0.01), age (p = 0.04), and serum glucose level (p = 0.01) had an independent significance for predicting it. This suggests that the rCBV ratio on PWI may be used to determine prognosis after thrombolysis in AIS.
Insights
The relative cerebral blood volume (rCBV) ratio on perfusion-weighted imaging (PWI) can predict poor outcomes in acute ischemic stroke (AIS) patients treated with IV t-PA. Lower rCBV ratios indicate a higher risk of adverse results, aiding in patient prognosis.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute ischemic stroke (AIS) requires prompt treatment to restore blood flow.
- Intravenous thrombolysis (IV t-PA) is a standard treatment for AIS.
- Assessing collateral circulation is crucial for predicting treatment response and patient outcomes.
Purpose of the Study:
- To evaluate the predictive value of the relative cerebral blood volume (rCBV) ratio from perfusion-weighted imaging (PWI) for poor outcomes in AIS patients treated with IV t-PA.
- To identify imaging biomarkers that can guide treatment decisions and improve patient prognostication.
Main Methods:
- A cohort of 58 AIS patients treated with IV t-PA was retrospectively analyzed.
- Diagnostic magnetic resonance imaging (MRI), including PWI and diffusion-weighted imaging (DWI), was performed.
- Poor outcome was defined as a Modified Rankin Scale (mRS) score >2 at 90 days post-stroke.
Main Results:
- 36.2% of patients (21/58) experienced a poor outcome (mRS 3-6).
- Poor outcome correlated with age, serum glucose, NIHSS score, T-occlusion, lesion volume on DWI, lower rCBV ratio on PWI, and non-recanalization.
- Independent predictors of poor outcome included non-recanalization, reduced rCBV ratio, age, and serum glucose level.
Conclusions:
- The rCBV ratio derived from PWI is a valuable tool for predicting prognosis in AIS patients undergoing IV t-PA therapy.
- Lower rCBV ratios are associated with a higher likelihood of poor outcomes.
- Integrating PWI rCBV assessment into routine imaging protocols may enhance patient management and therapeutic strategies in AIS.
