Practical Guide and Narrative Review of the Rat MCAO Model in Preclinical Stroke: Surgical Standards and MRI/DTI/MRS Biomarkers

This narrative review synthesizes practical, literature-derived guidance for implementing and interpreting the rat middle cerebral artery occlusion (MCAO) model, with emphasis on quantita-tive magnetic resonance readouts-structural MRI, diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS). Sources included PubMed, Scopus, and Web of Science (2000-2025). Reproducibility hinges on surgical standardization (body-size-matched filament selection and placement), intraoperative perfusion verification by laser Doppler flowmetry, temperature and physiological monitoring, and consistent post-operative care. We outline small-animal-appropriate acquisition exemplars, summarize diffusion metrics (fractional anisotropy, mean/axial/radial diffusivity) and spectroscopy markers (N-acetylaspartate, choline, creatine, myo-inositol, lactate), and describe how these indices map to tissue injury, white-matter integrity, and neuroplastic change. Validation strategies include edema-corrected lesion volume, hemorrhage screening (T2*/SWI), and alignment with a blinded 10-domain neurological composite. Where preclinical measures parallel patient observations, translational opportunities and caveats are highlighted. Adopting a standard-ized, literature-based workflow and quantitative imaging readouts can reduce variability, enhance cross-study comparability, and support the clinical use of the MCAO model.