The prognostic value of Arterial Spin Labeling MRI in Middle Cerebral Artery Ischemic Stroke Patients receiving thrombolytic therapy

Ahmed Effat Saied, Neurology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Nihal Mohamed El-Batouty, Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mohamed Abdel Salam Ali, Neurology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Merehan Reda Abo Alnaga, Neurology Department, Damietta Specialized Hospital, Damietta, EgyptFollow

Subject Area

Neuropsychiatry

Article Type

Original Study

Abstract

Background: Reestablishing blood circulation to the brain represents the primary proven treatment goal for acute ischaemic stroke (AIS). Recombinant tissue plasminogen activator (r-TPA) is a thrombolytic medication that enhances the rate of arterial blood flow restoration, reestablishes tissue perfusion, and leads to better functional recovery. This research aimed to examine changes in regional brain perfusion identified through arterial spin labeling (ASL) and how these changes correlate with functional recovery following ischemic stroke. Methods: This prospective observational research included 50 subjects with AIS in the middle cerebral artery (MCA) territory who were eligible for r-TPA treatment. Each patient underwent comprehensive neurological assessment and laboratory testing. Baseline and subsequent National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were documented. Unfavorable outcomes were characterized as mRS scores ranging from 2 to 6. Baseline and follow-up ASL magnetic resonance imaging (MRI) were performed, and relative cerebral blood flow (rCBF) was assessed by calculating the ratio of mean CBF in the affected brain area compared to the corresponding healthy region on the opposite side. Results: Following TPA administration, regional rCBF demonstrated a substantial increase compared to baseline measurements. Both baseline and follow-up rCBF values differed significantly between patients with favorable versus unfavorable outcomes (p=0.003 and p=0.005, respectively). Similarly, NIHSS scores at baseline, 24 hours, 7 days, and upon discharge demonstrated significant differences (p-values of 0.01, 0.02, 0.035, 0.03, respectively). Multiple linear regression analysis revealed that baseline relative rCBF and NIHSS scores at 24 h and one week were significant negative predictors of the 3-month mRS score (P=0.001, 0.027, and 0.044, respectively). Conclusions: Relative CBF measurements obtained through ASL MRI, along with NIHSS scores, may serve as predictors of 3-month functional outcomes and recovery in AIS patients receiving r-tPA. These findings suggest that ASL MRI could be utilized as a safe and noninvasive prognostic instrument for assessing acute ischemic stroke patients.

Recommended Citation

Saied, Ahmed Effat; El-Batouty, Nihal Mohamed; Ali, Mohamed Abdel Salam; and Alnaga, Merehan Reda Abo (2026) "The prognostic value of Arterial Spin Labeling MRI in Middle Cerebral Artery Ischemic Stroke Patients receiving thrombolytic therapy," Mansoura Medical Journal: Vol. 55 : Iss. 6 , Article 1.
Available at: https://doi.org/10.58775/2735-3990.1512