• J Neuroimaging · Mar 2015

    Comparative Study Clinical Trial

    Diffusion-weighted imaging volume as the best predictor of the diffusion-perfusion mismatch in acute stroke patients within 8 hours of onset.

    • Junya Aoki, Yohei Tateishi, Christopher L Cummings, Esteban Cheng-Ching, Paul Ruggieri, Muhammad Shazam Hussain, and Ken Uchino.
    • Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Ohio.
    • J Neuroimaging. 2015 Mar 1;25(2):217-25.

    BackgroundDiagnostic accuracies of standard NCCT, CTA, CTA-SI, FLAIR, and DWI to detect the diffusion-perfusion mismatch (DPM) were compared.MethodsStroke patients considered for endovascular therapy within 8 hours of onset were enrolled. DPM was defined as at least 160% mismatch between DWI and PWI volume.ResultsDPM was seen in 35 (71%) of 49 patients. ASPECTS on NCCT, CTA-SI, and DWI was 9 (8-9), 8 (6-9), and 7 (5-9) in mismatch group, and 6 (4-9), 6 (2-7), 5 (2-6) in nonmismatch group, respectively (P = .027, .006, and .001). Ischemic volume on CTA-SI and DWI was 4.6 (.2-13.0) cm(3) and 21.5 (9.7-44.0) cm(3) in mismatch group, and 61.5 (6.6-101.1) cm(3) and 94.9 (45.7-139.8) cm(3) in nonmismatch group (P = .003 and <.001). Significant collateralization on CTA-SI and FLAIR was seen in 80% and 88% in mismatch group, and 42% and 58% in nonmismatch group (P = .026 and .039). Odds ratios (95% CI) of DWI volume of ≤ 70 cm(3) to predict the mismatch was 30.17 (2.06-442.41) after adjusting for ASPECTSs on NCCT, CTA-SI, and DWI, 44.90 (2.75-732.73) for ischemic volume on CTA-SI, and 42.80 (3.05-601.41) for significant collateralization on CTA-SI and FLAIR (P = .013, .008, and .005).ConclusionsDWI volume was the best predictor of DPM.Copyright © 2014 by the American Society of Neuroimaging.

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