Role of Magnetic Resonance Imaging in the Evaluation of Ischemic Stroke: A Review Article

Background: Magnetic resonance imaging (MRI) plays a pivotal role in the early evaluation of acute ischemic stroke, offering high sensitivity for detecting cytotoxic edema, assessing tissue viability, and guiding reperfusion therapy. Its multimodal capability enables detailed evaluation of infarct core, penumbra, and vascular status. Objective: To review and synthesize current evidence on the diagnostic performance, clinical utility, and prognostic value of MRI modalities in acute ischemic stroke. Methods: A comprehensive literature search was performed across PubMed, Scopus, and Web of Science following PRISMA guidelines. A total of 100 studies involving more than 32,000 patients were included. Data were extracted on MRI modality distribution, diagnostic accuracy, imaging biomarkers, and workflow utility. Results were summarized in tables and narrative synthesis. Results: Diffusion-weighted imaging (DWI) was the most utilized modality and demonstrated the highest sensitivity for early ischemia. MRA effectively identified large vessel occlusions, while PWI provided reliable assessment of penumbra and treatment eligibility in late presentation. SWI contributed to detecting hemorrhagic transformation and clot characteristics. Multimodal MRI combinations yielded the highest diagnostic precision and improved patient selection for reperfusion therapy. Conclusion: MRI remains indispensable in acute ischemic stroke evaluation. Multimodal MRI protocols enhance diagnostic accuracy, support individualized decision-making, and improve clinical outcomes.