Magnetic Resonance Imaging Findings in Acute Stroke Patients: Correlation with Clinical Outcomes

Background: Acute stroke is a major cause of death and long-term disability worldwide, with rising incidence in low- and middle-income countries. Magnetic resonance imaging (MRI) enables early detection of ischemic and hemorrhagic stroke and may provide prognostic information. However, prospective data correlating MRI findings with clinical outcomes in Bangladesh remain limited.

Objective: To assess magnetic resonance imaging findings in acute stroke patients and evaluate their correlation with clinical outcomes.

Methods: This prospective cohort study was conducted at the National Institute of Ophthalmology & Hospital from January to December 2025. A total of 80 purposively selected patients presenting within 72 hours of symptom onset underwent brain MRI. Imaging variables included stroke type, lesion size, vascular territory, cortical involvement, diffusion restriction, and hemorrhagic transformation. Data were analyzed using SPSS version 23.0. Statistical significance was set at p<0.05.

Results: Among the participants, 50 (62.5%) had ischemic stroke and 30 (37.5%) had hemorrhagic stroke. Larger lesions (>30 mm) were significantly associated with unfavorable outcomes (mRS ≥3) (p=0.002). Cortical involvement showed a significant relationship with higher NIHSS scores and poor recovery (p=0.01). Diffusion-weighted imaging abnormalities demonstrated a strong positive correlation with baseline NIHSS scores (r=0.68, p<0.001). Hemorrhagic transformation occurred in 6 (12%) ischemic cases and was significantly associated with poor prognosis (p=0.03).

Conclusion: MRI findings, particularly lesion size, cortical involvement, and diffusion restriction, significantly correlate with short-term clinical outcomes in acute stroke patients. Early MRI assessment may improve prognostication and management decisions.