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We sought to validate the blood–brain barrier permeability measurements extracted from perfusion-weighted MRI through a relatively simple and frequently applied model, the Patlak model, by comparison with gold standard histology in a rat model of ischemic stroke.Eleven spontaneously hypertensive rats and 11 Wistar rats with unilateral 2-hour filament occlusion of the right middle cerebral artery underwent imaging during occlusion at 4 hours and 24 hours after reperfusion. Blood–brain barrier permeability was imaged by gradient echo imaging after the first pass of the contrast agent bolus and quantified by a Patlak analysis. Blood–brain barrier permeability was shown on histology by the extravasation of Evans blue on fluorescence microscopy sections matching location and orientation of MR images. Cresyl-violet staining was used to detect and characterize hemorrhage. Landmark-based elastic image registration allowed a region-by-region comparison of permeability imaging at 24 hours with Evans blue extravasation and hemorrhage as detected on histological slides obtained immediately after the 24-hour image set.Permeability values in the nonischemic tissue (marginal mean±SE: 0.15±0.019 mL/min[Combining Dot Above]100 g) were significantly lower compared to all permeability values in regions of Evans blue extravasation or hemorrhage. Permeability values in regions of weak Evans blue extravasation (0.23±0.016 mL/min[Combining Dot Above]100 g) were significantly lower compared to permeability values of in regions of strong Evans blue extravasation (0.29±0.020 mL/min[Combining Dot Above]100 g) and macroscopic hemorrhage (0.35±0.049 mL/min[Combining Dot Above]100 g). Permeability values in regions of microscopic hemorrhage (0.26±0.024 mL/min[Combining Dot Above]100 g) only differed significantly from values in regions of nonischemic tissue (0.15±0.019 mL/min[Combining Dot Above]100 g).Areas of increased permeability measured in vivo by imaging coincide with blood–brain barrier disruption and hemorrhage observed on gold standard histology.