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Related Experiment Videos

Refining the perfusion-diffusion mismatch hypothesis.

K S Butcher1, M Parsons, L MacGregor

  • 1Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Australia. kenneth.butcher@mh.org.au

Stroke
|May 26, 2005
PubMed
Summary
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Perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) mismatch definitions vary, but reperfusion, not mismatch definition, impacts stroke outcomes. This study compared common mismatch definitions in the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET).

Area of Science:

  • Neuroimaging
  • Stroke Imaging
  • Clinical Trials

Background:

  • The Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) investigates perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) mismatch for predicting thrombolysis response.
  • A standardized definition for PWI-DWI mismatch is currently lacking.
  • This study aimed to compare common mismatch definitions within the EPITHET trial.

Purpose of the Study:

  • To evaluate and compare various definitions of PWI-DWI mismatch.
  • To assess the impact of different PWI parameters (TTP, MTT, Tmax, FMT) and thresholds on mismatch volume calculation.
  • To determine the correlation between mismatch volume and infarct expansion.

Main Methods:

  • Generated PWI maps (TTP, MTT, Tmax, FMT) from raw perfusion images.

Related Experiment Videos

  • Measured DWI, apparent diffusion coefficient (ADC), and PWI volumes using planimetric and thresholding techniques.
  • Assessed correlations between mismatch volume (PWIvol-DWIvol) and DWI expansion (T2(Day 90-vol)-DWI(Acute-vol)).

    • Main Results:

    • Tmax and MTT hypoperfusion volumes were significantly lower than TTP and FMT volumes (P<0.001).
    • High rates of mismatch (> or =20%) were observed across definitions (89%-92%).
    • Applying a +4s PWI threshold reduced mismatch frequency; mismatch was not significantly different with ADC maps. Mismatch volume did not correlate with DWI expansion, but reperfusion inversely correlated with infarct growth (R=-0.51; P=0.009).

    Conclusions:

    • Deconvolution and PWI thresholds offer conservative estimates of tissue at risk, decreasing mismatch frequency.
    • The precise definition of PWI-DWI mismatch may be less critical than reperfusion's effect on tissue fate.
    • Reperfusion significantly influences stroke outcomes, irrespective of the specific mismatch definition used.