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Updated: Oct 28, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Diagnostic accuracy, time window estimation, and prognostic value of diffusion-weighted MRI in acute ischemic stroke:
1Magnetic Resonance, Zhongshan Hospital Affiliated to Xiamen University, 201-209 Hubin South Road, Siming District, Xiamen City, Fujian Province, 361004, China.
Background:
Diffusion-weighted imaging (DWI) is central to acute ischemic stroke (AIS) management; however, its performance varies across different clinical applications. This systematic review and meta-analysis comprehensively evaluated the diagnostic accuracy, time window estimation capability, and prognostic value of DWI in AIS.
Methods:
This registered systematic review searched three major databases for DWI studies in adult AIS patients published from 2010 to 2025. Risk of bias was assessed using QUADAS-2. The meta-analysis was performed in three distinct phases: (1) diagnostic accuracy, (2) time window estimation, and (3) prognostic value using a bivariate random-effects model. Extensive subgroup analyses were conducted to investigate sources of heterogeneity, including AI assistance, MRI field strength, study design, onset-to-DWI time, sequence type, lesion location, and stroke severity.
Results:
Of 34 eligible studies, 22 independent studies with 30 datasets were included in the meta-analysis across three phases. DWI demonstrated excellent diagnostic accuracy with a pooled sensitivity of 0.912 (95% CI: 0.888-0.932) and specificity of 0.959 (95% CI: 0.940-0.970). For time window estimation, DWI showed moderate performance with a pooled sensitivity of 0.786 (95% CI: 0.688-0.860) and specificity of 0.727 (95% CI: 0.668-0.780), with substantial heterogeneity and markedly lower accuracy in posterior circulation strokes. DWI-derived biomarkers demonstrated good prognostic value for predicting functional outcomes with a pooled sensitivity of 0.702 (95% CI: 0.540-0.825) and specificity of 0.904 (95% CI: 0.821-0.951).
Conclusion:
DWI offers excellent diagnostic accuracy for AIS (sensitivity: 0.912, specificity: 0.959) but only modest performance for time estimation (sensitivity: 0.786, specificity: 0.727). DWI-derived biomarkers show good prognostic value (sensitivity: 0.702, specificity: 0.904), while AI and ultra-fast MRI protocols demonstrate promise for improving clinical utility.
Study Design:
Registered systematic review and meta-analysis following PRISMA guidelines PROSPERO REGISTRATION: 2026 CRD420261376477.