To investigate the evolvement rules of TCM syndrome elements, and to analyze the correlations between neuroimaging characteristic and evolution of TCM syndrome elements. Methods:of acute ischemic stroke was used. A total of 120 patients attacked by acute ischemic stroke within 24 hour were selected from a polycentric and prospective randomized controlled trials database in this study. Magnetic resonance images were assessed via Alberta Stroke Program Early CT score(ASPECTS) method. The correlations between neuroimaging characteristic and evolution of TCM syndrome elements were analyzed according to Logistic analysis.Results:The main ischemic regions of ASPECTS included M5 (55.0%), internal capsule (40.9%), lenticular nucleus(30.8%). Caudate, internal capsule, insular ribbon, as well as cortex of M1, M5 and M6 (P<0.05) were significantly correlated to evolution of TCM syndrome elements within a week of the Stroke attack. Conclusion:ASPECTS-based neuroimaging characteristic is an important factor for evolution of TCM syndrome elements.