Amide proton transfer MRI can reflect tissue-level reperfusion status and predict functional outcome in patients with ischemic stroke

Motivation: Amide proton transfer (APT) imaging can clarify the metabolic microenvironment after ischemia. Few clinical studies to date have examined its use in ischemic tissue after reperfusion therapy, where the pH may return to normal physiological level. Goal(s): We used a numerical fitting of extrapolated semi-solid magnetization transfer reference (NEMR) method, which has been introduced to improve the detection of ischemia, to assess the tissue microenvironment after reperfusion therapy. Approach: Prospectively, case-control studyResults: We found both APT signal and mismatch pattern between APT and DWI (APT<DWI) could reflect tissue-level reperfusion status and provide complementary information to perfusion imaging for predicting 90-day neurological outcomes. Impact: We demonstrated the utility of APT signal and mismatch pattern between APT and DWI (APT<DWI) as effective biomarkers to characterize the tissue microenvironment and predict 90-day functional outcomes after reperfusion in patients with ischemic stroke.