Related Experiment Video
Updated: Mar 6, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
ASPECTS-based reperfusion status on arterial spin labeling is associated with clinical outcome in acute ischemic
Songlin Yu1,2, Samantha J Ma3, David S Liebeskind4
11 Department of Neurology, UCLA, Los Angeles, CA, USA.
Abstract:
The purpose of this study was to develop and evaluate a scoring system for assessing reperfusion status based on arterial spin labeled (ASL) perfusion MRI in acute ischemic stroke (AIS) patients receiving thrombolysis and/or endovascular treatment. Pseudo-continuous ASL with background suppressed 3D GRASE was acquired along with DWI in 90 patients within 24 h post-treatment. An automatic reperfusion scoring system (auto-RPS) was devised based on the Alberta Stroke Program Early CT Score (ASPECTS) template, and compared with manual RPS and DWI-ASPECTS. TICI (thrombolysis in cerebral infarction) scores were graded in 48 patients who received endovascular treatment. Favorable outcomes were defined by a modified Rankin Scale score of 0-2 at three months. Auto-RPS was positively correlated with DWI-ASPECTS (ρ = 0.6, P < 0.001) and was on average 1 point lower than DWI-ASPECTS ( P < 0.001). The area under the receiver operating characteristic curve for discriminating poor functional outcome (n = 90) was 0.75 (95% CI, 0.64-0.86) for manual RPS, 0.85 (95% CI, 0.76-0.94) for auto-RPS, and 0.81 (95% CI, 0.71-0.90) for DWI-ASPECTS. Multiple logistic regression analysis in the TICI-graded patients (n = 48) showed that auto-RPS is highly associated with functional outcome (OR = 25.2, 95% CI 4.02-496, P < 0.01). Post treatment auto-RPS within 24 h provides a useful tool to predict functional outcome in AIS patients.
Insights
A new automatic reperfusion scoring system (auto-RPS) using arterial spin labeled perfusion MRI effectively predicts functional outcomes in acute ischemic stroke (AIS) patients. This tool aids in assessing treatment effectiveness within 24 hours post-intervention.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute ischemic stroke (AIS) requires prompt assessment of reperfusion after treatment.
- Evaluating reperfusion status is crucial for predicting patient outcomes.
- Current methods for assessing reperfusion have limitations.
Purpose of the Study:
- To develop and validate an automated scoring system (auto-RPS) for reperfusion assessment.
- To utilize arterial spin labeled (ASL) perfusion MRI for this evaluation.
- To compare auto-RPS with existing methods like DWI-ASPECTS and manual RPS.
Main Methods:
- ASL perfusion MRI and DWI were acquired in 90 AIS patients within 24 hours post-treatment.
- An auto-RPS was created based on the ASPECTS template.
- Comparison with manual RPS, DWI-ASPECTS, and TICI scores (in 48 patients) was performed.
Main Results:
- Auto-RPS demonstrated a strong positive correlation with DWI-ASPECTS (ρ=0.6, P<0.001).
- Auto-RPS showed superior performance in predicting functional outcome compared to manual RPS and DWI-ASPECTS (AUC 0.85 vs 0.75 and 0.81).
- Auto-RPS was significantly associated with favorable functional outcomes (OR=25.2, P<0.01).
Conclusions:
- Post-treatment auto-RPS within 24 hours is a valuable tool for predicting functional outcomes in AIS patients.
- ASL perfusion MRI offers a reliable method for automated reperfusion assessment.
- This automated system can aid clinicians in managing AIS patients more effectively.
