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Clinical-diffusion mismatch predicts the putative penumbra with high specificity

Jane Prosser1, Ken Butcher, Louise Allport

  • 1Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.

Stroke
|July 16, 2005
PubMed
Abstract

Insights

Clinical-diffusion mismatch (CDM) identifies perfusion-diffusion (PWI-DWI) mismatch in acute stroke patients with high specificity. This finding suggests CDM may aid in selecting patients for therapies like thrombolysis.

Area of Science:

  • Neurology
  • Radiology
  • Stroke Imaging

Background:

  • Perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) are crucial for identifying the ischemic penumbra in acute stroke.
  • Complexities of PWI have limited its clinical application.
  • Clinical-diffusion mismatch (CDM) using the National Institutes of Health Stroke Scale (NIHSS) and DWI lesion volume is proposed as a surrogate for PWI-DWI mismatch.

Purpose of the Study:

  • To compare the diagnostic performance of CDM against PWI-DWI mismatch in acute stroke patients.
  • To evaluate CDM as a potential surrogate marker for PWI-DWI mismatch.
  • To assess the predictive value of CDM for early infarct expansion.

Main Methods:

  • Seventy-nine acute hemispheric stroke patients underwent imaging within 24 hours and subacutely.
  • CDM was defined as NIHSS ≥8 and DWI lesion volume ≤25 mL.
  • PWI-DWI mismatch and early infarct expansion were quantified using planimetric techniques.

Main Results:

  • In patients treated within 6 hours, CDM demonstrated high specificity (93%) and positive predictive value (95%) for PWI-DWI mismatch, but low sensitivity (53%).
  • Altering NIHSS or DWI cutpoints did not enhance CDM's performance.
  • Subacute DWI lesion expansion was significantly greater in patients with CDM.

Conclusions:

  • CDM (NIHSS ≥8, DWI ≤25 mL) effectively predicts PWI-DWI mismatch with high specificity, albeit with low sensitivity.
  • CDM is also predictive of DWI lesion expansion.
  • CDM may serve as a valuable tool for selecting acute stroke patients for reperfusion therapies, including thrombolysis.

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