{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:11:58Z","timestamp":1785337918848,"version":"3.55.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T00:00:00Z","timestamp":1750377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Acute ischemic stroke (AIS) is one of the prevalent types of stroke, characterized by high mortality and disability rates. For reperfusion therapy in acute cerebral infarction, early and accurate identification of ischemic penumbra, collateral circulation, and clinical grading is crucial for clinicians in devising effective treatment strategies and assessing prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients diagnosed with AIS were prospectively examined. In this study, the patients were divided into two groups based on National Institutes of Health Stroke Scale score, including the severe (score \u2265 6, 36 patients) and mild (score &amp;lt; 6, 51 patients) groups. Quantitative analysis included diffusion-weighted imaging (DWI) diffusion restricted maximum area, three-dimensional arterial spin labeling (3D-ASL) low-perfusion zone maximum area, and 3D-ASL cerebral blood flow (CBF) values. For qualitative analysis, four-dimensional triggered angiography non-contrast enhanced (4D-TRANCE) was used to assess hemodynamics features with a 4-point grading system. Differences among multiple groups were evaluated by analysis of variance. Receiver operating characteristic (ROC) curves were generated to assess the predictive ability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The severe group had 21 males and 15 females, while there were 27 males and 24 females in the mild group, with no statistically significant differences in age (64 \u00b1 12 versus 63 \u00b1 12 years, <jats:italic>P<\/jats:italic> &amp;gt; 0.05). Statistical differences were found between these two groups in 3D-ASL low-perfusion zone maximum area and 4D-TRANCE grade (<jats:italic>P<\/jats:italic> &amp;lt; 0.001). The area under the curve of the combined model of these two parameters was 0.950, with a sensitivity of 88.9% and a specificity of 92.2%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The combined application of 3D-ASL and 4D-TRANCE is of predictive significance in the clinical grading of acute ischemic cerebral infarction. It could provide a multiparametric and objective basis for further diagnosis and treatment selection.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnins.2025.1604551","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T05:22:57Z","timestamp":1750396977000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The value of multimodal MRI in the clinical grading of acute cerebral infarction"],"prefix":"10.3389","volume":"19","author":[{"given":"Haiyan","family":"Gui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxiu","family":"Lian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ningdi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e036785","DOI":"10.1136\/bmjopen-2020-036785","article-title":"Addition of arterial spin-labelled MR perfusion to conventional brain MRI: Clinical experience in a retrospective cohort study.","volume":"10","author":"Belani","year":"2020","journal-title":"BMJ Open"},{"key":"B2","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/S1474-4422(21)00359-8","article-title":"Management of atherosclerotic extracranial carotid artery stenosis.","volume":"21","author":"Bonati","year":"2022","journal-title":"Lancet Neurol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1080\/01616412.2020.1833147","article-title":"Determination of cerebral blood flow velocity and microembolic signals in essential thrombocytosis by transcranial doppler ultrasonography.","volume":"43","author":"Cinar","year":"2021","journal-title":"Neurol. Res."},{"key":"B4","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1177\/1747493020975229","article-title":"The ischemic penumbra: From concept to reality.","volume":"16","author":"Ermine","year":"2021","journal-title":"Int. J. Stroke"},{"key":"B5","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.neuropharm.2017.08.003","article-title":"The cerebral collateral circulation: Relevance to pathophysiology and treatment of stroke.","volume":"134","author":"Ginsberg","year":"2018","journal-title":"Neuropharmacology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"271","DOI":"10.2174\/1573405618666220509205920","article-title":"Diffusion-weighted imaging and arterial spin labeling for prediction of cerebral infarct volume in acute atherothrombotic stroke.","volume":"19","author":"Huang","year":"2023","journal-title":"Curr. Med. Imag."},{"key":"B7","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1177\/0271678X17743240","article-title":"Arterial spin labeling for the measurement of cerebral perfusion and angiography.","volume":"38","author":"Jezzard","year":"2020","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"B8","doi-asserted-by":"publisher","first-page":"5586","DOI":"10.12998\/wjcc.v10.i17.5586","article-title":"Three-dimensional arterial spin labeling and diffusion kurtosis imaging in evaluating perfusion and infarct area size in acute cerebral ischemia.","volume":"10","author":"Jiang","year":"2022","journal-title":"World J. Clin. Cases"},{"key":"B9","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1080\/08037051.2020.1715785","article-title":"Cardiovascular risk factors as determinants of cerebral blood flow - a cross-sectional and 6-year follow-up study.","volume":"29","author":"Kwater","year":"2020","journal-title":"Blood Press"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e28569","DOI":"10.1097\/MD.0000000000028569","article-title":"Arterial spin labeling signal ratio between the lesion and contralateral sides for evaluation of acute middle cerebral artery infarct.","volume":"101","author":"Lee","year":"2022","journal-title":"Medicine (Baltimore)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1007\/s00421-021-04693-6","article-title":"Cerebral blood flow velocity during simultaneous changes in mean arterial pressure and cardiac output in healthy volunteers.","volume":"121","author":"Lie","year":"2021","journal-title":"Eur. J. Appl. Physiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.1177\/0271678X16659497","article-title":"Regional hypoxic cerebral vasodilation facilitated by diameter changes primarily in anterior versus posterior circulation.","volume":"37","author":"Mikhail Kellawan","year":"2017","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"B13","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1161\/STROKEAHA.119.026556","article-title":"Regional arterial spin labeling perfusion defect is associated with early ischemic recurrence in patients with a transient ischemic attack.","volume":"51","author":"Nam","year":"2020","journal-title":"Stroke"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1936","DOI":"10.1109\/TBME.2019.2951082","article-title":"Segmentation-based blood flow parameter refinement in cerebrovascular structures using 4-D arterial spin labeling MRA.","volume":"67","author":"Phellan","year":"2020","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e46","DOI":"10.1161\/STR.0000000000000158","article-title":"2018 Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the american heart association\/american stroke association.","volume":"49","author":"Powers","year":"2018","journal-title":"Stroke"},{"key":"B16","doi-asserted-by":"publisher","first-page":"286","DOI":"10.2152\/jmi.71.286","article-title":"Evaluation of the ischemic penumbra and prognosis in acute cerebral infarction using cerebral blood flow and delay time derived from multi-delay pCASL imaging.","volume":"71","author":"Sasahara","year":"2024","journal-title":"J. Med. Invest."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1550","DOI":"10.3174\/ajnr.A5247","article-title":"Perfusion MR imaging using a 3D pulsed continuous arterial spin-labeling method for acute cerebral infarction classified as branch atheromatous disease involving the lenticulostriate artery territory.","volume":"38","author":"Shinohara","year":"2017","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"294","DOI":"10.2463\/mrms.rev.2019-0096","article-title":"Intracranial 3D and 4D MR angiography using arterial spin labeling: Technical considerations.","volume":"19","author":"Suzuki","year":"2020","journal-title":"Magn. Reson. Med. Sci."},{"key":"B19","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1159\/000519134","article-title":"Topographic evolution of anterior cerebral artery infarction and its impact on motor impairment.","volume":"51","author":"Thirugnanachandran","year":"2022","journal-title":"Cerebrovasc. Dis."},{"key":"B20","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1161\/STROKEAHA.119.027457","article-title":"Deep learning detection of penumbral tissue on arterial spin labeling in stroke.","volume":"51","author":"Wang","year":"2020","journal-title":"Stroke"},{"key":"B21","doi-asserted-by":"publisher","first-page":"5263","DOI":"10.1007\/s00330-020-07503-3","article-title":"Vessel-selective 4D MRA based on ASL might potentially show better performance than 3D TOF MRA for treatment evaluation in patients with intra-extracranial bypass surgery: A prospective study.","volume":"31","author":"Wang","year":"2021","journal-title":"Eur. Radiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1002\/jmri.27560","article-title":"Can 3D pseudo-continuous territorial arterial spin labeling effectively diagnose patients with recanalization of unilateral middle cerebral artery stenosis?","volume":"54","author":"Wang","year":"2021","journal-title":"J Magn. Reson. Imag."},{"key":"B23","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1161\/STROKEAHA.120.032994","article-title":"National institutes of health stroke scale as an outcome measure for acute stroke trials.","volume":"52","author":"Yamal","year":"2021","journal-title":"Stroke"}],"container-title":["Frontiers in Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2025.1604551\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T05:22:58Z","timestamp":1750396978000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2025.1604551\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,20]]},"references-count":23,"alternative-id":["10.3389\/fnins.2025.1604551"],"URL":"https:\/\/doi.org\/10.3389\/fnins.2025.1604551","relation":{},"ISSN":["1662-453X"],"issn-type":[{"value":"1662-453X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,20]]},"article-number":"1604551"}}