Visual Perfusion―Diffusion Mismatch Is Equivalent to Quantitative Mismatch

The concept of stroke MRI mismatch based on qualitative evaluation of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) has been applied in clinical practice for several years. The benefit of MRI in providing pathological evidence of ischemia before thrombolytic treatment has bee...

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Bibliographic Details
Published in:Stroke (1970) 2011-04, Vol.42 (4), p.1010-1014
Main Authors: LUBY, Marie, KU, Katherine D, LATOUR, Lawrence L, MERINO, José G, HSIA, Amie W, LYNCH, John K, WARACH, Steven
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Brain Ischemia - diagnosis
Brain Ischemia - drug therapy
Brain Ischemia - physiopathology
Brain Mapping - methods
Cerebrovascular Circulation - physiology
Diffusion Magnetic Resonance Imaging - methods
Evaluation Studies as Topic
Female
Humans
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Middle Aged
Nervous system
Neurology
Observer Variation
Predictive Value of Tests
Reproducibility of Results
Retrospective Studies
Stroke - diagnosis
Stroke - drug therapy
Stroke - physiopathology
Thrombolytic Therapy - methods
Ultrasonic investigative techniques
Vascular diseases and vascular malformations of the nervous system
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Summary:The concept of stroke MRI mismatch based on qualitative evaluation of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) has been applied in clinical practice for several years. The benefit of MRI in providing pathological evidence of ischemia before thrombolytic treatment has been demonstrated. The purpose of this study is to determine the reliability of the qualitative method and compare it with quantitative mismatch measurement in thrombolytic-treated patients. Patients (n=70) were selected from the Lesion Evolution of Stroke and Ischemic On Neuroimaging (LESION) database if they: (1) were treated with intravenous recombinant tissue plasminogen activator; (2) had a pretreatment MRI with evaluable DWI and PWI; and (3) had acute ischemic lesion volume >10 mL on DWI as determined by core imaging laboratory measurements. Quantitative mismatch was defined as a difference of >50 mL between abnormal mean transit time and DWI volumes. Sample characteristics and postdischarge modified Rankin Scale for the positive mismatch patients were compared between the subgroups identified by qualitative versus quantitative methods. Patient characteristics and thrombolytic outcomes (sex, age, National Institutes of Health Stroke Scale, mismatch volume, and modified Rankin Scale) did not differ for mismatch patients identified by qualitative versus quantitative methods. Qualitative mismatch selection among neurologists had a high sensitivity (0.82), specificity (0.80), accuracy (0.81), and positive predictive value (0.88) compared with quantitative measurements. We observed that qualitative evaluation of mismatch identified the same thrombolytic-treated patients compared with retrospective quantitative mismatch measurements.
ISSN:0039-2499
1524-4628
DOI:10.1161/strokeaha.110.603290