Correlation Between Magnetic Resonance Imaging Biomarkers and Blood Biomarkers in Acute Ischemic Stroke

Background: Acute ischemic stroke (AIS) is a major cause of mortality. Despite substantial advances in stroke diagnosis, investigation, and therapeutic management, the need for improved prognostic assessment remains an important clinical challenge. This study aimed to evaluate the role of combining magnetic resonance imaging (MRI)-derived and blood biomarkers in predicting functional outcomes in AIS at 3 months. Methods: A retrospective observational cohort study used data from Prince Mohd bin Naser Hospital in Saudi Arabia to integrate clinical variables and MRI-derived and blood biomarkers from adult patients with AIS. Results: The primary outcome, 3-month functional status, was assessed by the modified Rankin Scale (mRS) (good outcome: mRS < 3; poor outcome: mRS ≥ 3). The corrected analytical cohort included 100 patients. Among the 100 patients (median age: 61 years; male: 75.0%), 67 and 33 had good and poor 3-month outcomes, respectively. Compared with the good outcome group, the poor outcome group had significantly higher National Institutes of Health Stroke Scale (NIHSS) score at admission, which was the strongest discriminator between the two groups, and a trend toward a lower lesion’s mean apparent diffusion coefficient (ADC) that did not reach statistical significance. Multivariable analysis showed the best predictive performance (area under the curve (AUC): 0.934; cross-validated AUC: 0.906) with the base model consisting of admission NIHSS, lesion’s mean ADC, neutrophil percentage, and red cell distribution width; this cross-validated performance was not statistically distinguishable from a comparator model using NIHSS alone (CV-AUC: 0.898). Correlation analyses showed weak-to-moderate relationships between MRI-derived and blood biomarkers, with no correlations remaining significant after false discovery rate correction. Conclusions: Admission NIHSS score was the most powerful and consistent predictor of the 3-month outcome, while the incremental value of the multimarker model over NIHSS alone requires confirmation in larger, externally validated cohorts.