2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T764,Multimodal imaging has expanded treatment for patients with acute ischemic stroke with large vessel occlusion. Blood-brain barrier (BBB) disruption measured in the ischemic core is associated with hemorrhagic transformation. However, the associations between core BBB disruption (cBBBD) and baseline clinical/imaging variables, as well as 3-month outcome, have not been explored. This is a retrospective multicenter analysis of consecutive anterior circulation patients with acute ischemic stroke with large vessel occlusion, presenting over a 4-year time period, who were transferred from a primary to a comprehensive stroke center for possible endovascular therapy, with magnetic resonance imaging that included perfusion-weighted imaging before transfer. Magnetic resonance imaging scans were processed using RAPID software to generate penumbral imaging variables. Perfusion-weighted images were processed to detect and quantify contrast leakage; cBBBD was calculated as the average of all leaky voxels in the ischemic core. Poor functional outcome was defined as a modified Rankin Scale score of >2 at 3 months. Linear regression was used except for the outcome, which used logistic regression, controlling for age, stroke severity, and baseline functional status. Out of 411 patients transferred for endovascular therapy, 291 were included in this analysis with a median age of 74 years; 49% were female patients. The median National Institutes of Health Stroke Scale score was 13, the mean core volume was 32.3 mL, and the mean cBBBD was 2.1%. 71% of patients underwent endovascular therapy. Admission National Institutes of Health Stroke Scale score ( In acute ischemic stroke with large vessel occlusion, disruption of the BBB in the core lesion is independently associated with clinical outcome. cBBBD represents a new imaging profile for acute stroke that may help guide treatments.31:Td9f, BACKGROUND: Multimodal imaging has expanded treatment for patients with acute ischemic stroke with large vessel occlusion. Blood-brain barrier (BBB) disruption measured in the ischemic core is associated with hemorrhagic transformation. However, the associations between core BBB disruption (cBBBD) and baseline clinical/imaging variables, as well as 3-month outcome, have not been explored. METHODS: This is a retrospective multicenter analysis of consecutive anterior circulation patients with acute ischemic stroke with large vessel occlusion, presenting over a 4-year time period, who were transferred from a primary to a comprehensive stroke center for possible endovascular therapy, with magnetic resonance imaging that included perfusion-weighted imaging before transfer. Magnetic resonance imaging scans were processed using RAPID software to generate penumbral imaging variables. Perfusion-weighted images were processed to detect and quantify contrast leakage; cBBBD was calculated as the average of all leaky voxels in the ischemic core. Poor functional outcome was defined as a modified Rankin Scale score of >2 at 3 months. Linear regression was used except for the outcome, which used logistic regression, controlling for age, stroke severity, and baseline functional status. RESULTS: Out of 411 patients transferred for endovascular therapy, 291 were included in this analysis with a median age of 74 years; 49% were female patients. The median National Institutes of Health Stroke Scale score was 13, the mean core volume was 32.3 mL, and the mean cBBBD was 2.1%. 71% of patients underwent endovascular therapy. Admission National Institutes of Health Stroke Scale score ( P <0.001) and glucose level ( P =0.033) were independently correlated with cBBBD. All imaging variables correlated strongly with cBBBD ( P <0.001). The strongest correlation was 0.50, observed between cBBBD and mismatch ratio ( r 2 =0.254). Increasing cBBBD was independently associated with poor functional outcome (adjusted odds ratio, 1.16 [CI, 1.03–1.32]; P =0.019; n=279), indicating that for every 1% increase in cBBBD, the odds of having a poor functional outcome increase by 16%. CONCLUSIONS: In acute ischemic stroke with large vessel occlusion, disruption of the BBB in the core lesion is independently associated with clinical outcome. cBBBD represents a new imaging profile for acute stroke that may help guide treatments. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"MRI Perfusion-Weighted Imaging: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on MRI Perfusion-Weighted Imaging (modality). Clinician-written summaries and actionable practice insights. 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The median National Institutes of Health Stroke Scale score was 13, the mean core volume was 32.3 mL, and the mean cBBBD was 2.1%. 71% of patients underwent endovascular therapy. Admission National Institutes of Health Stroke Scale score (","abstract":"$30","keywords":["angiography","blood-brain barrier","endovascular procedures","ischemic stroke","magnetic resonance imaging"],"pubmed_id":"42089148","conclusions":"","publication_date":"2026-05-06T00:00:00"},"crossref":{"DOI":"10.1161/strokeaha.126.055955","URL":"https://doi.org/10.1161/strokeaha.126.055955","ISSN":["0039-2499","1524-4628"],"link":[{"URL":"https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.126.055955","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Core Blood-Brain Barrier Disruption in Patients With Large Vessel Occlusion"],"author":[{"given":"Richard","family":"Leigh","sequence":"first","affiliation":[{"name":"Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 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Gui de Chauliac, Montpellier, France."}]},{"given":"Adrián","family":"Valls Carbó","sequence":"additional","affiliation":[{"name":"Department of Neurosciencies, Germans Trias I Pujol University Hospital, Badalona, Spain (A.V.C., M.H.-P.)."}]},{"given":"María","family":"Hernández-Pérez","sequence":"additional","affiliation":[{"name":"Department of Neurosciencies, Germans Trias I Pujol University Hospital, Badalona, Spain (A.V.C., M.H.-P.)."}]},{"given":"Frédérique","family":"Charbonneau","sequence":"additional","affiliation":[{"name":"Department of Radiology (F.C.), Hôpital Fondation A. de Rothschild, Paris, France."}]},{"given":"Caroline","family":"Arquizan","sequence":"additional","affiliation":[{"name":"Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team Turc, France (N.V., A.t.S., C.A., P.S.)."},{"name":"Department of Neurology (A.t.S., C.A.), CHRU Gui de Chauliac, Montpellier, France."}]},{"given":"Anne","family":"Wacongne","sequence":"additional","affiliation":[{"name":"Department of Neurology, Nimes University Hospital, France (A.W.)."}]},{"given":"Denis","family":"Sablot","sequence":"additional","affiliation":[{"name":"Department of Neurology, Perpignan Hospital, France (D.S.)."}]},{"given":"Vincent","family":"Costalat","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology (V.C.), CHRU Gui de Chauliac, Montpellier, France."}]},{"given":"Canan","family":"Ozsancak","sequence":"additional","affiliation":[{"name":"CRFA Le COTEAU-UGECAM, La Chapelle-Saint Mesmin, France (C.O.)."}]},{"given":"Clara","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, University Hospital Center of Orleans, France (C.C.)."}]},{"given":"Marco","family":"Pasi","sequence":"additional","affiliation":[{"name":"Department of Neurology (M.P.), Centres d’Investigation Clinique–Innovation Technologique (CIC-IT) 1415, INSERM 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Occlusion","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"modality","value":"Endovascular Therapy","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"modality","value":"MRI Perfusion-Weighted Imaging","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"sample_size","value":"n=291","value_numeric":291},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"study_design","value":"Retrospective Multicenter Cohort Study","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"warning","value":"Median patient age of 74 years suggests an older cohort; findings may not generalize to younger stroke populations.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously — while results are compelling, this is a retrospective study and cBBBD is not yet a validated clinical tool; prospective studies are needed.","value_numeric":null},{"paper_doi":"10.1161/strokeaha.126.055955","tag_type":"warning","value":"The study population was limited to patients transferred between stroke centers with pre-transfer MRI, which is not standard at all centers and may introduce selection bias.","value_numeric":null}],"summaries":{"what_studied":"This retrospective multicenter study evaluated core blood-brain barrier disruption (cBBBD) measured via MRI perfusion-weighted imaging in 291 anterior circulation large vessel occlusion (LVO) stroke patients transferred from primary to comprehensive stroke centers over 4 years, examining associations with baseline clinical/imaging variables and 3-month functional outcome.","key_result":"Each 1% increase in cBBBD was independently associated with a 16% higher odds of poor functional outcome (mRS >2 at 3 months; aOR 1.16 [95% CI, 1.03–1.32]; P=0.019). Admission NIHSS (P<0.001) and glucose (P=0.033) were independently correlated with cBBBD; mismatch ratio showed the strongest imaging correlation (r=0.50, r²=0.254).","limitations":"- Retrospective design with potential selection bias; only patients transferred from primary to comprehensive stroke centers are included, limiting generalizability.\n- Significant reduction from 411 eligible to 291 included patients (and 279 for outcome analysis) raises concern for incomplete data.\n- cBBBD measurement relies on RAPID software contrast leakage detection, and thresholds/methodology are not independently validated in this cohort.","practice_takeaway":"In LVO stroke, higher core BBB disruption on admission MRI independently predicts worse 3-month outcomes — consider cBBBD as an additional imaging biomarker alongside core volume and mismatch ratio when counseling patients and families. This metric may eventually help refine patient selection for endovascular therapy, though prospective validation is needed."}}],"initialOffset":1,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"MRI Perfusion-Weighted Imaging"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"MRI Perfusion-Weighted Imaging"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"MRI Perfusion-Weighted Imaging"}}}]]

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