Diffusion-weighted imaging reversal after reperfusion therapy in acute ischemic stroke: associations with white matter hyperintensities and cerebral microbleeds.

Authors

Nora Bannert, Paula Klassen, Regina Krijatov, Amir Dooat, Anastasia Nosanova, Jens Dreyhaupt, Hans-Peter Müller, Karl Georg Haeusler, Mona Laible

Published in

Neurological research and practice. Volume 8. Issue 1. Oct 29, 2026. Epub Oct 29, 2026.

Abstract

White matter hyperintensities (WMH) and cerebral microbleeds (CMBs) are common MRI markers of chronic small-vessel brain injury and have been associated with adverse outcomes after ischemic stroke. However, whether these markers influence early ischemic tissue reversibility following reperfusion therapy remains unclear. We therefore investigated their associations with diffusion-weighted imaging (DWI) lesion reversal, hemorrhagic complications, and short-term functional outcome after MRI-guided reperfusion therapy.
In this retrospective single-center study, consecutive patients with acute ischemic stroke undergoing MRI-guided intravenous thrombolysis, with or without additional mechanical thrombectomy, were included. According to the institutional protocol, follow-up MRI was planned 24 ± 6 h after treatment to assess DWI lesion evolution, WMH volume, and CMBs. DWI reversal was defined as a reduction of ≥ 25% in baseline DWI lesion volume. Multivariable regression analyses were performed to identify predictors of DWI reversal, intracerebral hemorrhage, and functional outcome at hospital discharge.
Among 345 patients (median age 74 years [IQR 63-82], 48.1% female), 45 (13%) additionally underwent mechanical thrombectomy. DWI reversal occurred in 76 patients (22.0%) and was not associated with baseline WMH volume, CMBs, initial infarct volume, treatment modality, or thrombolysis time window. Higher baseline NIHSS and modified Rankin Scale scores were associated with lower odds of DWI reversal, whereas hypercholesterolemia was independently associated with increased odds of DWI reversal. We found no evidence of an association of WMH burden or CMB presence with intracerebral hemorrhage or of an independent association with functional outcome. Fourteen patients (4.1%) developed new CMBs on follow-up MRI.
We found no evidence of an association between baseline WMH volume or CMB presence and early DWI lesion reversal or hemorrhagic complications following reperfusion therapy in this cohort. These findings provide no evidence that these two chronic MRI markers are major determinants of early infarct tissue reversibility. Larger multicenter studies incorporating comprehensive small-vessel disease phenotyping and long-term follow-up are warranted.

PMID:
42966855
Bibliographic data and abstract were imported from PubMed on 01 Nov 2026.

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