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Peer-reviewedCC BY 4.0Neurological Research and Practice

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

  • Nora Bannert1
  • Paula Klassen1
  • Regina Krijatov1
  • Amir Dooat1
  • Anastasia Nosanova1,2
  • Jens Dreyhaupt3
  • Hans-Peter Müller1,4,5
  • Karl Georg Haeusler1
  • Mona Laible1,6
6 affiliations
  1. 1Department of Neurology, University Hospital Ulm, Oberer Eselsberg 45, Ulm, 89081 Germany
  2. 2Institute for Anatomy and Cell Biology, University of Ulm, Ulm, Germany
  3. 3Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
  4. 4Department of Nuclear Medicine, School of Medicine, University Hospital Ulm, Ulm, Germany
  5. 5Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
  6. 6German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
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Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s42466-026-00545-w.

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Cite

BibTeXRIS
BibTeX
@article{bannert2026diffusionweighted,
  title = {{Diffusion-weighted imaging reversal after reperfusion therapy in acute ischemic stroke: associations with white matter hyperintensities and cerebral microbleeds}},
  author = {Nora Bannert and Paula Klassen and Regina Krijatov and Amir Dooat and Anastasia Nosanova and Jens Dreyhaupt and Hans-Peter Müller and Karl Georg Haeusler and Mona Laible},
  journal = {Neurological Research and Practice},
  year = {2026},
  month = oct,
  doi = {10.1186/s42466-026-00545-w},
  url = {https://doi.org/10.1186/s42466-026-00545-w},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Diffusion-weighted imaging reversal after reperfusion therapy in acute ischemic stroke: associations with white matter hyperintensities and cerebral microbleeds
AU  - Nora Bannert
AU  - Paula Klassen
AU  - Regina Krijatov
AU  - Amir Dooat
AU  - Anastasia Nosanova
AU  - Jens Dreyhaupt
AU  - Hans-Peter Müller
AU  - Karl Georg Haeusler
AU  - Mona Laible
PY  - 2026
DA  - 2026/10/29
JO  - Neurological Research and Practice
DO  - 10.1186/s42466-026-00545-w
UR  - https://doi.org/10.1186/s42466-026-00545-w
AB  - Background: 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.  Methods: 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.  Results: 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.  Conclusions: 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.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s42466-026-00545-w.
SN  - 2524-3489
ER  -