3D-ASL imaging of cerebral blood flow in predicting early poor prognosis of intravenous thrombolysis in acute ischemic stroke

Background: Early prediction of poor prognosis after intravenous thrombolysis in acute ischemic stroke (AIS) is critical for clinical management. Three-dimensional arterial spin labeling (3D-ASL) allows non-invasive quantification of cerebral blood flow (CBF), but its value in predicting early outcomes remains unclear. Methods: This single-center retrospective study assessed the data of 60 patients with AIS who received intravenous thrombolysis between January 2022 and January 2023. Patients with a reduction of ≤5 points in their National Institutes of Health Stroke Scale (NIHSS) score at discharge were defined as having a poor early outcome and were classified into a poor prognosis group (n = 30) or a good prognosis group (n = 30) if otherwise. CBF values, derived from 3D-ASL imaging, were compared between the two groups across different post-labeling delay (PLD) times and brain regions. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of CBF for early poor prognosis, and the sensitivity, specificity, and area under the curve (AUC) were calculated. Results: At a PLD of 2500 ms, CBF values in both the infarct core and ischemic penumbra (IP) regions were significantly lower in the poor prognosis group compared with the good prognosis group (p < 0.05). ROC analysis showed AUCs of 0.757 (IP, sensitivity 90%, specificity 63.3%) and 0.800 (infarct core, sensitivity 70%, specificity 86.7%). Combined CBF improved AUC to 0.882 (sensitivity 80%, specificity 80%). Conclusions: CBF values from 3D-ASL (PLD 2500 ms) in the infarct core and IP may predict early poor prognosis after thrombolysis in AIS, with combined assessment showing optimal performance. Findings require validation in larger cohorts.

Acute ischemic stroke; Magnetic resonance imaging; 3D-ASL; Cerebral blood flow; Adverse prognosis

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