The Role of Leukoaraiosis and Microbleeds in Acute Ischemic Stroke Outcome Prediction

TL;DR

This study shows that MRI can help predict outcomes in acute ischemic stroke patients, with leukoaraiosis linked to worse recovery.

Contribution

The study demonstrates a significant correlation between leukoaraiosis severity and poor stroke outcomes using MRI data.

Findings

More severe leukoaraiosis is associated with higher rates of unfavorable functional outcomes.

Leukoaraiosis severity correlates with reduced cerebral blood flow values.

CMBs were not significantly linked to functional outcomes due to low prevalence.

Abstract

Background/Objectives: Acute ischemic stroke (AIS) is one of the leading causes of mortality worldwide and the primary cause of acquired neurological disability in adults. As part of a stroke magnetic resonance (MR) protocol, fluid-attenuated inversion recovery (FLAIR) plays an important role in the detection and assessment of the degree of leukoaraiosis (LA), while susceptibility-weighted angiography (SWAN) detects cerebral microbleeds (CMBs). The present study sought to examine the association of the degree of LA and CMBs with absolute cerebral blood flow (aCBF) values and functional outcome prediction in patients with AIS. Methods: We conducted a cross-sectional study including a total of 205 male and female patients. All of the patients underwent brain magnetic resonance imaging (MRI) examinations in the first 24 h following suspected AIS, using the stroke protocol. A modified Rankin scale (mRS) was used to evaluate the degree of functional dependence and disability three months after AIS. Results: The incidence of an unfavorable functional outcome evidently increased with more pronounced LA modalities (p < 0.05; χ2 test). The Kruskal–Wallis test found a statistically significant difference in aCBF values in relation to a degree of LA (p < 0.05). As there were a small number of multiple CMBs, no statistically significant difference was found based on the detection and degree of CMBs with aCBF and functional outcome; hence, the hypothesis was not entirely confirmed. Conclusions: This study indicates the reliability of MRI application in the initial diagnostic evaluation in order to gain an additional insight into the prediction of AIS outcomes. We demonstrated that LA correlates significantly with an unfavorable functional outcome after AIS, with decreased perfusion values. On the other hand, a higher proportion of unfavorable functional outcomes was observed in patients with CMBs. However, this result was not statistically significant and should be interpreted with caution.

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