{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:38:57Z","timestamp":1787027937477,"version":"build-2736575974"},"reference-count":31,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Post-stroke cognitive impairment (PSCI) affects ~40% of survivors. Diffusion Tensor Imaging Analysis Along the Perivascular Space (DTI-ALPS) is a fast, contrast-free surrogate of perivascular (glymphatic-aligned) diffusivity that may stratify PSCI risk. We systematically synthesized evidence on the diagnostic and prognostic performance of ALPS in ischemic stroke. Methods: Following PRISMA 2020, we searched PubMed\/MEDLINE, Scopus, and Web of Science from inception to August 2025 for human ischemic stroke studies reporting ALPS and cognitive or functional outcomes. Eligible designs were cohort or case\u2013control. Outcomes included group differences, associations with cognition (Montreal Cognitive Assessment [MoCA]\/Mini-Mental State Examination [MMSE]), prognostic accuracy for PSCI\/functional outcome, and longitudinal change. Risk of bias was appraised with QUADAS-2 (diagnostic) and QUIPS (prognostic). The protocol was registered on OSF. Heterogeneity among studies precluded a meta-analysis. Results: Five single-center cohorts (n per cohort 29\u2013120) from Asia, Europe, and the USA used 3T DTI with ventricular-level ALPS ROIs. Across studies, ALPS was lower after stroke, with early ipsilesional depression and partial recovery over weeks to months. ALPS correlated with cognition (MoCA r \u2248 0.43\u20130.56) and discriminated early cognitive impairment (AUC 0.868; sensitivity 96%, specificity 66%). Follow-up ALPS predicted poor 6-month outcome (AUC 0.786). In lacunar stroke with small-vessel disease, higher baseline ALPS related to better cognitive trajectories and lower incident dementia risk (HR \u2248 0.33), though associations attenuated after adjustment for diffusion microstructural covariates (PSMD\/MD). Reporting of acquisition parameters and ROI methods varied; overall risk of bias was moderate. Conclusions: DTI-ALPS shows consistent post-stroke reductions, recovery-sensitive trajectories, and promising\u2014though context-dependent\u2014prognostic value for PSCI and longer-term outcomes. Clinical translation will require standardized acquisition\/analysis, multimodal adjustment, prespecified cut-offs, and prospective multicenter validation.<\/jats:p>","DOI":"10.3390\/diagnostics15222905","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T15:38:09Z","timestamp":1763393889000},"page":"2905","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Diffusion Tensor Imaging Along the Perivascular Space (DTI-ALPS) in Ischemic Stroke: A Systematic Review of Diagnostic and Prognostic Performance for Post-Stroke Cognitive Impairment"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2961-0489","authenticated-orcid":false,"given":"Mirela Loredana","family":"Grigoras","sequence":"first","affiliation":[{"name":"Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei-Cristian","family":"Bondar","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, \u201cTitu Maiorescu\u201d University, Calea V\u0103c\u0103re\u0219ti 187, 040051 Bucuresti, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4711-4315","authenticated-orcid":false,"given":"Felix","family":"Bratosin","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iulia Georgiana","family":"Bogdan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia","family":"Marc","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1111\/phn.13503","article-title":"Prevalence and Risk Factors of Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis","volume":"42","author":"Ma","year":"2025","journal-title":"Public Health Nurs."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"147ra111","DOI":"10.1126\/scitranslmed.3003748","article-title":"A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid \u03b2","volume":"4","author":"Iliff","year":"2012","journal-title":"Sci. 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