Optimal definition for PWI DWI mismatch in acute ischemic stroke patients

Although the perfusion-weighted imaging/diffusion-weighted imaging (PWI/DWI) mismatch model has been proposed to identify acute stroke patients who benefit from reperfusion therapy, the optimal definition of a mismatch is uncertain. We evaluated the odds ratio for a favorable clinical response in mi...

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Bibliographic Details
Published in:	Journal of cerebral blood flow and metabolism Vol. 28; no. 5; pp. 887 - 891
Main Authors:	Kakuda, Wataru, Lansberg, Maarten G, Thijs, Vincent N, Kemp, Stephanie M, Bammer, Roland, Wechsler, Lawrence R, Moseley, Michael E, Parks, Michael P, Albers, Gregory W
Format:	Journal Article
Language:	English
Published:	London, England SAGE Publications 01-05-2008 Lippincott Williams & Wilkins Sage Publications Ltd
Subjects:	Acute Disease Aged Aged, 80 and over Biological and medical sciences Brain Ischemia - pathology Brain Ischemia - therapy Diffusion Magnetic Resonance Imaging - methods Diffusion Magnetic Resonance Imaging - standards Female Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Male Medical sciences Middle Aged Nervous system (semeiology, syndromes) Neurology Odds Ratio Patient Selection Predictive Value of Tests Reproducibility of Results Sensitivity and Specificity Stroke - pathology Stroke - therapy Thrombolytic Therapy Vascular diseases and vascular malformations of the nervous system ischemic penumbra thrombolysis perfusion-weighted imaging diffusion-weighted imaging acute ischemic stroke mismatch Human Cerebral infarction Stroke Nervous system diseases Diffusion imaging Cardiovascular disease Cerebral disorder Vascular disease Perfusion imaging Central nervous system disease Brain ischemia Ischemic penumbra Cerebrovascular disease
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Summary:	Although the perfusion-weighted imaging/diffusion-weighted imaging (PWI/DWI) mismatch model has been proposed to identify acute stroke patients who benefit from reperfusion therapy, the optimal definition of a mismatch is uncertain. We evaluated the odds ratio for a favorable clinical response in mismatch patients with reperfusion compared with no reperfusion for various mismatch ratio thresholds in patients enrolled in the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. A mismatch ratio of 2.6 provided the highest sensitivity (90%) and specificity (83%) for identifying patients in whom reperfusion was associated with a favorable response. Defining mismatch with a larger PWI/DWI ratio may provide greater power for detecting beneficial effects of reperfusion.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0271-678X 1559-7016
DOI:	10.1038/sj.jcbfm.9600604