Amide Proton Transfer‐Weighted MRI, Associations with Clinical Severity and Prognosis in Ischemic Strokes

Background The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS) scores have important shortcomings. Amide proton transfer‐weighted (APTw) imaging might offer more valuable information in ischemic strokes assessment. Purpose To utilize APTw, apparent diffusion coefficient (ADC), and computed tomography perfusion (CTP) for the assessment of clinical symptom severity and 90‐day prognosis in patients diagnosed with ischemic stroke. Study Type Prospective. Subjects 61 patients (mean age 63.2 ± 9.7 years; 46 males, 15 females) with ischemic strokes were included in the study. Field Strength/Sequence 3T/turbo spin echo (TSE) T 1 ‐weighted imaging, T 2 ‐weighted imaging, T 2 ‐fluid attenuated inversion recovery (T 2 ‐FLAIR), diffusion‐weighted imaging (DWI), and single‐shot TSE APTw imaging. Assessment APTw, ADC, and CTP were used to compare patient subgroups and construct a prognostic nomogram model. Statistical Tests Kolmogorov–Smirnov test, t ‐test, Mann–Whitney U test, chi‐square test, Pearson correlation analysis, multivariate logistic regression analysis, decision curve analysis (DCA), receiver operating characteristic curves (ROCs). The significance threshold was set at P < 0.05. Results Correlation analysis revealed that APTw and NIHSS exhibit the highest correlation ( r = −0.634, 95% confidence interval [CI] −0.418 to −0.782), surpassing that of ADC and lesion size. Multivariable analysis revealed APTw (odds ratio [OR] 0.905, 95% CI 0.845–0.970), ADC (OR 0.745, 95% CI 0.609–0.911), and infarct core‐cerebral blood volume (IC‐CBV) (OR 0.547, 95% CI 0.310–0.964) as potential risk factors associated with a poor prognosis. The nomogram model demonstrated the highest predictive efficacy, with an area under the curve (AUC) of 0.960 (95% CI 0.911–0.988), exceeding that of APTw, ADC, and IC‐CBV individually. Data Conclusion The APTw technique holds potential value in categorizing and managing patients with ischemic stroke, offering guidance for the implementation of clinical treatment strategies. Level of Evidence 1 Technical Efficacy Stage 2