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Updated: Apr 12, 2026

A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Prolonged Venous Transit on MRI As A Prognostic Biomarker in Acute Ischemic Stroke: A Feasibility Study
Derek A Tsang1, Mona Gad1, Andrew Cho1
1From the Department of Radiology (D.A.T., M.G., A.C., K.L., V.S.Y.), Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA; Department of Neuroradiology (H.A.S.), MD Anderson Medical Center, Houston, TX, USA; Department of Neuroradiology (D.A.L.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA; Cooper Neurological Institute (M.K.), Cooper University, Camden, NJ, USA; Department of Neurointerventional Surgery (F.K.H.), Queen's University, Honolulu, HI, USA; Neuroendovascular Program (A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Neurovascular Centre & RADIS Lab (A.A.D.), St. Michael's Hospital, Toronto Metropolitan University, Toronto, ON; Department of Neurology (D.S.L.), Keck School of Medicine - University of Southern California, Los Angeles, CA, USA; Department of Interventional Neuroradiology (G.W.A.), Stanford Medical Center, Palo Alto, California, USA; Department of Radiology (T.D.F.), Neuroendovascular Program, University Medical Center Münster, Germany.
None:
Prolonged venous transit (PVT) on CT perfusion is an established marker of poor collaterals and stroke severity; feasibility on MR perfusion (MRP) is uncertain. We evaluated feasibility and prognostic value of PVT on MRP in 59 patients with suspected acute ischemic stroke using a "straight-to-MRI" workflow. Board-certified neuroradiologists visually defined PVT as Tmax ≥10 s in the superior sagittal sinus and/or torcula. Pearson correlation tested associations between binary PVT and discharge NIHSS and 90-day modified Rankin Scale (mRS) in the full cohort and treated sub-cohort (IV thrombolysis and/or thrombectomy). PVT correlated with worse outcomes in the full cohort (NIHSS r=0.469, p=0.002; mRS r=0.387, p=0.02) and more strongly in treated patients (NIHSS r=0.678, p=0.005; mRS r=0.631, p=0.01). These findings demonstrate that PVT can be assessed on MRP and is a potentially promising post-revascularization prognostic biomarker aligning with CTP-based physiology; larger studies are needed.
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