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Peer-reviewedCC BY-NC-ND 4.0BMC Medical Imaging

Diagnostic accuracy, time window estimation, and prognostic value of diffusion-weighted MRI in acute ischemic stroke: a systematic review and meta-analysis

  • Yueqin Wang1
  • LuXin Guo2
  1. 1Magnetic Resonance, Zhongshan Hospital Affiliated to Xiamen University, 201-209 Hubin South Road, Siming District, Xiamen City, Fujian Province 361004 China
  2. 2Department of Radiology, Zhongshan Hospital Affiliated to Xiamen University, 201-209 Hubin, South Road, Siming District, Xiamen City, Fujian Province 361004 China
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Abstract

Background: Diffusion-weighted imaging (DWI) is central to acute ischemic stroke (AIS) management; however, its performance varies across different clinical applications. This systematic review and meta-analysis comprehensively evaluated the diagnostic accuracy, time window estimation capability, and prognostic value of DWI in AIS.

Methods: This registered systematic review searched three major databases for DWI studies in adult AIS patients published from 2010 to 2025. Risk of bias was assessed using QUADAS-2. The meta-analysis was performed in three distinct phases: (1) diagnostic accuracy, (2) time window estimation, and (3) prognostic value using a bivariate random-effects model. Extensive subgroup analyses were conducted to investigate sources of heterogeneity, including AI assistance, MRI field strength, study design, onset-to-DWI time, sequence type, lesion location, and stroke severity.

Results: Of 34 eligible studies, 22 independent studies with 30 datasets were included in the meta-analysis across three phases. DWI demonstrated excellent diagnostic accuracy with a pooled sensitivity of 0.912 (95% CI: 0.888–0.932) and specificity of 0.959 (95% CI: 0.940–0.970). For time window estimation, DWI showed moderate performance with a pooled sensitivity of 0.786 (95% CI: 0.688–0.860) and specificity of 0.727 (95% CI: 0.668–0.780), with substantial heterogeneity and markedly lower accuracy in posterior circulation strokes. DWI-derived biomarkers demonstrated good prognostic value for predicting functional outcomes with a pooled sensitivity of 0.702 (95% CI: 0.540–0.825) and specificity of 0.904 (95% CI: 0.821–0.951).

Conclusion: DWI offers excellent diagnostic accuracy for AIS (sensitivity: 0.912, specificity: 0.959) but only modest performance for time estimation (sensitivity: 0.786, specificity: 0.727). DWI-derived biomarkers show good prognostic value (sensitivity: 0.702, specificity: 0.904), while AI and ultra-fast MRI protocols demonstrate promise for improving clinical utility.

Study design: Registered systematic review and meta-analysis following PRISMA guidelines

PROSPERO registration: 2026 CRD420261376477.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12880-026-02592-w.

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BibTeXRIS
BibTeX
@article{wang2026diagnostic,
  title = {{Diagnostic accuracy, time window estimation, and prognostic value of diffusion-weighted MRI in acute ischemic stroke: a systematic review and meta-analysis}},
  author = {Yueqin Wang and LuXin Guo},
  journal = {BMC Medical Imaging},
  year = {2026},
  month = jul,
  doi = {10.1186/s12880-026-02592-w},
  url = {https://doi.org/10.1186/s12880-026-02592-w},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Diagnostic accuracy, time window estimation, and prognostic value of diffusion-weighted MRI in acute ischemic stroke: a systematic review and meta-analysis
AU  - Yueqin Wang
AU  - LuXin Guo
PY  - 2026
DA  - 2026/07/01
JO  - BMC Medical Imaging
DO  - 10.1186/s12880-026-02592-w
UR  - https://doi.org/10.1186/s12880-026-02592-w
AB  - Background: Diffusion-weighted imaging (DWI) is central to acute ischemic stroke (AIS) management; however, its performance varies across different clinical applications. This systematic review and meta-analysis comprehensively evaluated the diagnostic accuracy, time window estimation capability, and prognostic value of DWI in AIS.  Methods: This registered systematic review searched three major databases for DWI studies in adult AIS patients published from 2010 to 2025. Risk of bias was assessed using QUADAS-2. The meta-analysis was performed in three distinct phases: (1) diagnostic accuracy, (2) time window estimation, and (3) prognostic value using a bivariate random-effects model. Extensive subgroup analyses were conducted to investigate sources of heterogeneity, including AI assistance, MRI field strength, study design, onset-to-DWI time, sequence type, lesion location, and stroke severity.  Results: Of 34 eligible studies, 22 independent studies with 30 datasets were included in the meta-analysis across three phases. DWI demonstrated excellent diagnostic accuracy with a pooled sensitivity of 0.912 (95% CI: 0.888–0.932) and specificity of 0.959 (95% CI: 0.940–0.970). For time window estimation, DWI showed moderate performance with a pooled sensitivity of 0.786 (95% CI: 0.688–0.860) and specificity of 0.727 (95% CI: 0.668–0.780), with substantial heterogeneity and markedly lower accuracy in posterior circulation strokes. DWI-derived biomarkers demonstrated good prognostic value for predicting functional outcomes with a pooled sensitivity of 0.702 (95% CI: 0.540–0.825) and specificity of 0.904 (95% CI: 0.821–0.951).  Conclusion: DWI offers excellent diagnostic accuracy for AIS (sensitivity: 0.912, specificity: 0.959) but only modest performance for time estimation (sensitivity: 0.786, specificity: 0.727). DWI-derived biomarkers show good prognostic value (sensitivity: 0.702, specificity: 0.904), while AI and ultra-fast MRI protocols demonstrate promise for improving clinical utility.  Study design: Registered systematic review and meta-analysis following PRISMA guidelines  PROSPERO registration: 2026 CRD420261376477.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12880-026-02592-w.
SN  - 1471-2342
ER  -