MRI quantitative biomarkers focusing on apparent diffusion coefficient for predicting hemorrhagic transformation...

BackgroundHemorrhagic transformation (HT) is a serious complication following mechanical thrombectomy in acute ischemic stroke (AIS), significantly impacting clinical outcomes. Magnetic resonance imaging (MRI)-based quantitative biomarkers, particularly the apparent diffusion coefficient (ADC), have been investigated as predictors of HT, but findings across studies remain inconsistent. This study aimed to evaluate the diagnostic performance of quantitative MRI biomarkers, especially ADC values, for predicting any HT in AIS patients undergoing mechanical thrombectomy.MethodsA systematic search of PubMed, Embase, Scopus, and Web of Science was performed for studies published up to 20 July 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed by QUADAS-2. Eligible studies assessed quantitative biomarkers based on pre-treatment MRI for predicting any HT post-thrombectomy. Data on sensitivity, specificity, area under the curve (AUC), and other diagnostic metrics were extracted. Pooled estimates were calculated using a bivariate random-effects model. Heterogeneity was assessed via I² statistics, and publication bias was evaluated using Deeks' funnel plot.ResultsEleven studies were included. The pooled sensitivity and specificity of models based on ADC for predicting HT were 0.75 (95% CI: 0.66-0.82, I²: 0%) and 0.73 (95% CI: 0.65-0.80, I²: 58.91%), respectively. The summary AUC was 0.79 (95% CI: 0.75-0.83), indicating strong diagnostic performance. Additional biomarkers such as infarct core volume, white matter hyperintensity and arterial spin labeling demonstrated potential but lacked sufficient data for meta-analysis.ConclusionsDiffusion-weighted imaging shows good diagnostic accuracy for predicting HT after mechanical thrombectomy. Integration of advanced imaging biomarkers into pre-thrombectomy protocols could enhance clinical decision-making and patient safety.