ObjectivesTo determine the relationship between patient-reported outcome measures (PROMs) and volumetric imaging markers in acute ischemic stroke (AIS).Patients and MethodsPatients presenting at Massachusetts General Hospital between February 14, 2017 and February 5, 2020 with a confirmed AIS by MRI were eligible and underwent a telephone interview including PROM-10 questionnaires 3-15 months after stroke. White matter hyperintensity (VWMH) and brain volumes (VBrain) were automatically determined using admission clinical MRI. Stroke lesions were manually segmented and volumes calculated (VLesion). Multivariable and ordinal regression analyses were performed to identify associations between global and PROM-10 subscores with brain volumetrics and clinical variables.ResultsUtilizing data from 167 patients (mean age: 64.7; 41.9% female), higher VWMHwas associated with worse global physical (β=-0.6), global mental (β=-0.65), physical health (OR=0.68), social satisfaction (OR=0.66), fatigue (OR=0.69) and social activities (OR=0.59) scores. Higher VLesionwas associated with poorer global mental (β=-0.79), mental health (OR=0.68), physical (OR=0.66) and social activities (OR=0.55), and emotional distress (OR=0.68) scores. Higher VBrainwas linked to better global mental (β=0.93), global physical (β=0.79), mental health (OR=1.54) and physical activities (OR=1.72) scores.ConclusionsNeuroimaging biomarkers were significantly associated with PROMs, where higher VWMHand VLesionled to worse outcome, while higher VBrainwas protective. The inclusion of neuroimaging analyses and PROMs in routine assessment provides enhanced understanding of post-stroke outcomes.