rADC and MCA plaque are independent neuroimaging predictors of early neurological deterioration in single subcortical infarction patients, while CSVD burden showed no significant association.
Early neurological deterioration (END) occurred in 24.8% of single subcortical infarction (SSI) patients within 72 hours of admission.
Lower rADC values were an independent predictor of END, with an optimal cut-off of 0.61 demonstrating sensitivity of 84% and specificity of 50%.
Presence of MCA plaques was an independent predictor of END in SSI patients.
Lower ADC and rADC values, larger maximum infarct diameter, more proximal axial infarct location, and presence of MCA plaques were all significantly associated with END on univariate analysis.
CSVD burden and individual CSVD imaging markers were not significantly associated with END in SSI patients.
This research suggests that among patients who suffer a specific type of small stroke called a single subcortical infarction (SSI), about one in four will experience early neurological deterioration (END) — meaning their symptoms worsen significantly within the first three days of hospitalization. The study, which looked at 129 patients, found that two features visible on MRI brain scans could independently predict which patients were most at risk: a lower value on a measure called relative apparent diffusion coefficient (rADC), which reflects how severely brain tissue is damaged, and the presence of plaques in a major brain artery called the middle cerebral artery (MCA), detected using specialized vessel wall imaging. Importantly, the study found that the relative ADC measure (rADC) was a better predictor than the standard ADC measure, with a specific cut-off value of 0.61 identifying high-risk patients with 84% sensitivity. Patients with rADC below this threshold were over four times more likely to experience early worsening, and those with MCA plaques were nearly three times more likely. By contrast, the overall burden of small vessel disease in the brain — often considered a risk factor for stroke complications — was not significantly linked to early deterioration in this group. This research suggests that routine MRI data collected at hospital admission, specifically rADC values and vessel wall imaging for MCA plaques, could help doctors identify SSI patients at higher risk of early worsening and potentially guide more individualized treatment decisions. The findings highlight the value of comprehensive neuroimaging in the acute stroke setting for risk stratification.
Wu Y, Chen L, Sun Z, Pi J, Wu J. (2026). Neuroimaging characteristics associated with early neurological deterioration in single subcortical infarction patients.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1849475