Association of dynamic changes in ASPECTS perfusion scores derived from dual-time-point multi-post-labeling delay arterial spin labeling with 90-day functional outcome in acute ischemic stroke.

OBJECTIVE: To investigate whether dynamic changes in Alberta Stroke Program Early CT Score (ASPECTS) perfusion scores derived from dual-time-point multi-post-labeling delay arterial spin labeling (multi-PLD ASL) are associated with 90-day functional outcome in patients with acute ischemic stroke (AIS). METHODS: This single-center retrospective study included 464 patients with anterior-circulation AIS who underwent multi-PLD ASL at baseline and approximately 1 week after onset. Cerebral blood flow (CBF)-ASPECTS, cerebral blood volume (CBV)-ASPECTS, arterial transit time (ATT)-ASPECTS, relative perfusion values, and infarct core volume (ICV) were compared between favorable (modified Rankin Scale [mRS] 0-2) and unfavorable (mRS 3-6) outcome groups. Correlation and receiver operating characteristic (ROC) analyses were performed. RESULTS: The favorable outcome group showed greater improvements in CBF-ASPECTS, CBV-ASPECTS, ATT-ASPECTS, relative cerebral blood flow (rCBF), and relative cerebral blood volume (rCBV), together with a greater reduction in relative arterial transit time (rATT). Increased ICV was more pronounced in the unfavorable outcome group. Dynamic ASL indicators were significantly correlated with 90-day mRS scores. Single indicators showed moderate discriminative ability, whereas combined models performed better. The clinical-imaging model showed the highest area under the curve (AUC) of 0.846. CONCLUSION: Short-term changes on dual-time-point multi-PLD ASL were associated with 90-day functional outcome in AIS. Dynamic ASPECTS perfusion scores may serve as an interpretable imaging supplement for prognosis assessment, but should be combined with clinical information.