Background: Stroke remains a primary etiology of death and disability globally. The primary objective of stroke imaging is to assess the parenchyma, perfusion, and intracranial circulation to differentiate salvageable tissue from infarcted tissue.

Aim: To evaluate the role of MRI in the assessment of stroke, determine the vascular territories involved, and analyze MR spectroscopy (MRS) findings in ischemic stroke.

Materials and Methods: A prospective cross-sectional study was conducted on 55 patients (aged 18–80 years) presenting with clinical suspicion of stroke at Jamia Hamdard, New Delhi. Imaging was performed using a 1.5T Siemens MAGNETOM ESSENZA. The protocol included T1W, T2W, FLAIR, DWI, GRE, 3D TOF MRA, and MRS.

Results: 44 (80%) patients had ischemic infarcts. Hypertension (58.18%) and Diabetes (52.73%) were the predominant risk factors. The MCA was the most common territory involved (45.46%). DWI detected 100% of acute infarcts, compared to 58.06% by T2W. MRS showed decreased NAA and a lactate peak in 100% of acute infarct cases.

Conclusion: MRI, particularly utilizing DWI and MRS, is a highly sensitive modality for early stroke detection, offering metabolic insights into the ischemic penumbra that conventional imaging lacks.

KEYWORDS: Stroke Evaluation, MRI, MR Spectroscopy, Parenchyma, Intracranial Circulation.