Predicting prognosis in subacute ischemic stroke through brain perfusion and collateral circulation with 4D ASL

Background Four-dimensional arterial spin labeling (4D ASL) is an innovative method of ASL perfusion that utilizes five post-labeling delays to calculate the arterial transit time and corrected cerebral blood flow (cCBF). This study aimed to evaluate cerebral perfusion levels and collateral circulation in patients with subacute ischemic stroke (IS) using 4D ASL and further examine their correlation with prognosis. Methods We included 28 patients with subacute IS, all of whom presented with moderate-to-severe stenosis or occlusion of the unilateral M1 segment of the middle cerebral artery (M1-MCA) or the internal carotid artery (ICA) terminus ± M1-MCA. The patient’s prognosis was represented by the modified Rankin Scale (mRS) score at 3 months after the first onset. Perfusion levels were compared between groups with favorable prognosis (mRS ≤ 2) and poor prognosis (mRS > 2). Receiver operating characteristic (ROC) curve analysis was conducted on perfusion based on prognosis. Results Perfusion indicators in the cerebral hemisphere were found to accurately predict prognosis, and significant differences were observed in the meningeal branch of the middle cerebral artery (MCA) and MCA deep penetrating branch. The increase in cCBF in the group with good prognosis, whether on the narrow or the normal side, was greater than in the group with poor prognosis at post-labeling delays of 1.0 s to 1.5 s. Perfusion indicators demonstrate high diagnostic efficacy for predicting prognosis. Conclusions Cerebral perfusion levels and collateral circulation, as assessed via 4D ASL in patients with subacute IS associated with unilateral intracranial arterial stenosis, can effectively predict patient outcomes. (ClinicalTrial.gov ID: NCT06289036, registration date: February 24th, 2024, retrospectively registered)