Harnessing ASL (arterial spin labeling) for hyper acute and acute stroke management: a comparative analysis with DTI (diffusion tensor imaging)

Abstract Background Cerebro-vascular stroke remains a leading cause of disability and mortality worldwide. The purpose of this study was to evaluate the fundamental role of arterial spin labeling perfusion imaging in the diagnosis and management of hyperacute and acute ischemic stroke, with comparing the predictive performance of ASL with that of diffusion tensor imaging (DTI). Methods A hundred patients were included in this study. All cases were clinically assessed by stroke consultant followed by brain imaging including conventional MRI, DWI, DTI and ASL perfusion technique. Findings from both techniques were then correlated with clinical outcome at 3 months, as measured by the NIHSS score. Results This prospective study included 100 patients with recent stroke who were enrolled within two days of symptom onset. All patients underwent clinical follow-up after three months, and findings were correlated with MR imaging parameters. Patients were categorized based on the time of presentation and management into two groups . Relative CBF demonstrated the highest predictive accuracy for favorable outcome, with a sensitivity of 89% and specificity of 88%. The optimal cut-off values were > 48% for rCBF, > 20 mL/100 g/min for absolute CBF, and > 0.6 for rFA. Among patients with intact FA tracts, 38 (90.5%) showed a reduction in NIHSS score at 3-month follow-up. Conclusion Arterial spin labeling proved particularly valuable in hyperacute and acute stroke management, demonstrating higher predictive accuracy than DTI. While the combined use of ASL and DTI achieved the greatest accuracy in outcome prediction, ASL alone may be more advantageous in patients presenting within 4.5 h of symptom onset, where rapid decision-making is critical.