Associations Among CTA Collateral Scores, Multimodal MRI Lesion Volumes, and Clinical Severity in Acute Middle Cerebral Artery Infarction

<b>Background/objectives</b>: In this study, we aimed to investigate acute infarct volume on magnetic resonance diffusion-weighted imaging (MRI DWI), chronic infarct volume on FLAIR (fluid-attenuated inversion recovery), hypoperfused area volume on PWI (perfusion-weighted imaging), stenosis locations and rates on CT (computerized tomography) angiography, CT angiography collateral scoring, and correlation of background data and etiological factors with neurological clinical findings in patients with acute middle cerebral infarction. <b>Methods</b>: A total of 117 patients with MCA (middle cerebral artery) infarction were hospitalized for diagnosis and treatment after undergoing CT angiography within 9 h of symptom onset. Comparative results of Souza's collateral score system, MRI parameters, and clinical outcomes were determined. <b>Results</b>: According to the Souza CS system, 23 patients were in the malignant profile and 94 in the good profile. There was a statistically significant difference between the malignant and benign profiles in terms of DWI volume, hypoperfused area volume on PWI sequence, white matter assessment using the Fazekas scale, and supratentorial and infratentorial chronic infarct volume on the FLAIR sequence (<i>p</i> < 0.001, <i>p</i> < 0.001, <i>p</i> < 0.001, <i>p</i> < 0.001, <i>p</i> < 0.001). <b>Conclusions</b>: Patients with a malignant profile on CTA may have a larger infarct volume and worse functional outcome. This should be recognized, and these patients should be followed up more carefully and attentively than those with good collateral scores.