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• Clinical Article •
Value of quantitative assessment of white matter hyperintensities on MRI in prognostic prediction for AIS patients
ZHAO Yuwei  ZHU Li  FAN Xian  LU Yu  WANG Tianle 

Cite this article as ZHAO Y W, ZHU L, FAN X, et al. Value of quantitative assessment of white matter hyperintensities on MRI in prognostic prediction for AIS patients[J]. Chin J Magn Reson Imaging, 2026, 17(6): 36-45, 54. DOI:10.12015/issn.1674-8034.2026.06.005.


[Abstract] Objective To investigate the value of white matter hyperintensity (WMH) quantitatively assessed by MRI imaging in predicting the clinical prognosis of patients with acute ischemic stroke (AIS) caused by middle cerebral artery (MCA) occlusion.Materials and Methods This retrospective study included 168 AIS patients with middle cerebral artery occlusion treated between July 2021 and July 2024. All patients underwent CT perfusion (CTP) imaging within 24 h of admission, and ischemic volumes at different thresholds were obtained (VTmax>4 s, VTmax>6 s, VTmax>8 s, VTmax>10 s, VCBF<30%, VCBF<38%, and VCBF<50%). The hypoperfusion intensity ratio (HIR) was calculated as the ratio of VTmax>10 s to VTmax>6 s. MRI was performed within 7 days, and regional WMH volumes (periventricular cap, periventricular, deep, and juxtacortical) were measured on T2 fluid-attenuated inversion recovery (FLAIR) images. Short-term neurological improvement was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≤ 1 or a decrease of ≥ 8 points at 7 days. Ninety-day outcome was assessed using the modified Rankin Scale (mRS), with mRS scores of 0-2 classified as good outcome and 3-6 as poor outcome. Spearman correlation analysis was used to evaluate associations between WMH volume and cerebral perfusion status. Binary logistic regression analysis was performed to identify independent predictors of short-term and 90-day outcomes. Combined Model 1 was constructed using baseline NIHSS score, VTmax>6 s, and VCBF<30%. On this basis, periventricular WMH volume was added to establish Combined Model 2. Model performance was evaluated using receiver operating characteristic (ROC) curves, DeLong test, calibration curves, and decision curve analysis.Results Of the 168 patients, 93 achieved short-term neurological improvement, and 83 had a good 90 - day outcome. Total WMH volume was significantly lower in the short-term improvement group than in the non-improvement group (P < 0.05). Multivariate logistic regression analysis with short-term neurological improvement as the outcome variable demonstrated that VTmax>6 s (OR = 0.992, 95% CI: 0.986 to 0.998, P = 0.009), VCBF<30% (OR = 0.981, 95% CI: 0.964 to 0.999, P = 0.036), and total volume of white matter hyperintensities (WMH) (OR = 0.957, 95% CI: 0.928 to 0.987, P = 0.005) were independently associated with short-term neurological improvement in patients. Increased periventricular cap WMH volume was an independent risk factor for poor 90- day outcome (OR = 1.327, 95% CI: 1.089 to 1.618, P = 0.005). Baseline NIHSS score, VTmax>6 s, VCBF<30%, and periventricular cap WMH volume were independently associated with poor 90-day outcome. A regression model combining baseline NIHSS score, VTmax>6 s, VCBF<30%, and periventricular cap WMH volume achieved the best performance for predicting 90 - day outcome, with an area under the curve (AUC) of 0.895 (95% CI: 0.846 to 0.945; P < 0.001), sensitivity of approximately 81.2%, and specificity of approximately 90.3%. This model outperformed the prediction model based solely on baseline NIHSS score, VTmax>6 s, and VCBF<30%. The Delong test indicated an absolute difference of 0.029 between the two models (Z = 2.06, P = 0.03). The Hosmer-Lemeshow test and calibration curve both indicate that Combined Model 1 and Combined Model 2 exhibit favorable calibration performance. Decision curve analysis showed that the net benefit of combined prediction model 2 was consistently higher than that of combined prediction model 1.Conclusions A larger total volume of WMH measured by MRI in the early stages of hospitalization is associated with a lower rate of short-term neurological improvement in AIS patients. Increased periventricular cap WMH volume is an independent risk factor for poor 90-day outcome in patients with AIS. A regression model integrating baseline NIHSS score, cerebral perfusion status, and periventricular cap WMH volume demonstrates good prognostic performance for predicting 90-day functional outcomes in patients with AIS.
[Keywords] acute ischemic stroke；middle cerebral artery occlusion；white matter lesions；magnetic resonance imaging；cerebral perfusion；prognosis

ZHAO Yuwei1, 2   ZHU Li2   FAN Xian2   LU Yu2   WANG Tianle2*  

1 Nantong University Nantong Clinical College, Nantong 226600, China

2 Department of Radiology, Nantong First People's Hospital, Affiliated to Southeast University, Nantong 226600, China

Corresponding author: WANG T L, E-mail: wangtianle9192@163.com

Conflicts of interest   None.

Received  2025-12-30
Accepted  2026-06-07
DOI: 10.12015/issn.1674-8034.2026.06.005
Cite this article as ZHAO Y W, ZHU L, FAN X, et al. Value of quantitative assessment of white matter hyperintensities on MRI in prognostic prediction for AIS patients[J]. Chin J Magn Reson Imaging, 2026, 17(6): 36-45, 54. DOI:10.12015/issn.1674-8034.2026.06.005.

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