ADVANCED MAGNETIC RESONANCE IMAGING BIOMARKERS FOR PROGNOSIS AND TREATMENT RESPONSE IN ACUTE ISCHEMIC STROKE

Introduction: Acute ischemic stroke remains a leading cause of mortality and long-term disability worldwide, with substantial heterogeneity in clinical presentation and outcomes. Conventional clinical and imaging parameters are often insufficient to accurately predict prognosis or treatment response in the hyperacute and acute phases. Advanced magnetic resonance imaging techniques have emerged as promising tools to characterize tissue viability, collateral status, and microstructural injury beyond standard diffusion-weighted and perfusion imaging. Objective: The main objective of this systematic review is to evaluate the prognostic and predictive value of advanced magnetic resonance imaging biomarkers in patients with acute ischemic stroke. Secondary objectives include assessing their association with functional outcomes, infarct growth, hemorrhagic transformation, response to reperfusion therapies, and their potential role in individualized clinical decision-making. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. Eligible studies published within the last five years evaluated advanced magnetic resonance imaging biomarkers in acute ischemic stroke and reported prognostic or treatment response outcomes. Data were synthesized qualitatively according to biomarker type, imaging technique, and clinical relevance. Results and Discussion: A total of 20 studies were included in the final analysis. The evidence indicates that biomarkers derived from advanced diffusion models, perfusion metrics, susceptibility-weighted imaging, and functional and structural connectivity analyses provide incremental prognostic information beyond conventional imaging. These biomarkers demonstrated associations with functional recovery, infarct progression, and therapeutic response, although heterogeneity in methodologies and outcome measures was observed. Conclusion: Advanced magnetic resonance imaging biomarkers offer clinically meaningful insights into prognosis and treatment response in acute ischemic stroke. Their integration into clinical workflows may support more precise risk stratification and individualized therapeutic strategies, although further standardization and prospective validation are required.