Comparative Analysis of MRI DWI/ADC Changes with Clinical Recovery in Stroke Patients

Abstract

Objective:  To determine the relationship between MRI diffusion weighted imaging (DWI), apparent diffusion coefficient (ADC) changes, and clinical recovery in acute ischemic stroke patients.

Materials and Methods:  This prospective observational study was conducted at the Radiology Department of Lady Reading Hospital, Peshawar, from January 2025 to June 2025. A total of 234 patients with acute ischemic stroke were included. All patients underwent MRI with DWI and ADC sequences within 24 hours of symptom onset. Clinical severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional recovery was evaluated using the Modified Rankin Scale (mRS) and Barthel Index at discharge and 30-day follow-up. Statistical analysis included Pearson correlation and multivariate regression to assess the association between imaging parameters and clinical outcomes.

Results: DWI reversal on follow-up imaging was observed in 38.6% of patients and was strongly associated with improved functional outcomes (p=0.002). Multivariate analysis confirmed baseline DWI volume, mean ADC value, and NIHSS score as independent predictors of recovery.
Conclusion: DWI lesion size, ADC value, and initial NIHSS score are significant predictors of clinical recovery in acute ischemic stroke patients. Incorporation of MRI-based diffusion imaging in routine stroke assessment improves early prognostication and guides management decisions.