Effect of arterial transit artifact in arterial spin labeling imaging on prognostic outcomes in ischemic stroke patients: A meta-analysis

Arterial transit artifact (ATA) in arterial spin labeling (ASL) imaging have been suggested to predict functional outcomes in ischemic stroke patients; however, their clinical utility remains debated. Existing studies are predominantly limited by small sample sizes, single-center designs, and low levels of evidence. Furthermore, insufficient technical standardization and methodological heterogeneity across investigations have constrained the generalizability of conclusions. This study therefore aims to evaluate the prognostic implications of ATA in ischemic stroke patients through a systematic synthesis of current evidence. A systematic literature search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases to identify potentially eligible studies published from database inception through February 2025. Pooled effect estimates were derived using standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes, both reported with 95 % confidence interval (CI), to quantify the association between ATA and prognostic outcomes in ischemic stroke patients. All statistical analyses were executed using STATA 17.0, adhering to Cochrane Collaboration methodological standards for meta-analytic precision. The meta-analysis incorporated 11 studies encompassing 747 participants. Pooled analyses demonstrated a significant association between the presence of ATA and favorable prognostic outcomes, evidenced by standardized mean difference (SMD = -0.91, 95 % CI: -1.13 to -0.70; p < 0.001) and risk ratio (RR = 1.43, 95 % CI: 1.22-1.67; p < 0.001). Sensitivity analyses confirmed the robustness of these effect estimates, revealing no substantial alterations upon sequential study exclusion. Publication bias assessments via Begg and Egger tests indicated no statistically significant evidence of small-study effects or publication bias. This meta-analysis demonstrates a significant association between ATA and favorable functional outcomes in ischemic stroke patients, supporting their potential utility as a clinically actionable imaging biomarker for prognostic stratification.