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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.

AJNR. American Journal of Neuroradiology
|April 10, 2026
PubMed

Insights

Prolonged venous transit (PVT) on MR perfusion imaging is feasible and predicts poor outcomes in acute ischemic stroke patients. This imaging marker shows similar prognostic value to CT perfusion, especially after treatment.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Prolonged venous transit (PVT) on CT perfusion (CTP) indicates poor collateral circulation and stroke severity.
  • The feasibility and prognostic significance of PVT on MR perfusion (MRP) remain uncertain.

Purpose of the Study:

  • To evaluate the feasibility of assessing PVT on MRP.
  • To determine the prognostic value of PVT on MRP in patients with acute ischemic stroke.

Main Methods:

  • A
  • straight-to-MRI
  • workflow was used in 59 patients.
  • PVT was visually defined as Tmax ≥10 seconds in specific venous sinuses.
  • Pearson correlation assessed the association between PVT and clinical outcomes (NIHSS, mRS).

Main Results:

  • PVT was feasible to assess on MRP.
  • PVT correlated with worse discharge NIHSS and 90-day mRS in the overall cohort.
  • The correlation between PVT and poor outcomes was stronger in patients receiving IV thrombolysis and/or thrombectomy.

Conclusions:

  • PVT can be assessed on MRP, offering a potentially valuable prognostic biomarker.
  • MRP-derived PVT aligns with CTP-based physiological assessments.
  • Larger studies are warranted to confirm these findings.

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