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Related Experiment Videos

CT-NIHSS mismatch does not correlate with MRI diffusion-perfusion mismatch.

Steven R Messé1, Scott E Kasner, Julio A Chalela

  • 1Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. messe@mail.med.upenn.edu

Stroke
|June 2, 2007
PubMed
Summary
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Alberta Stroke Program Early CT Score (ASPECTS) and NIH Stroke Scale (NIHSS) mismatch did not correlate with MRI diffusion-perfusion mismatch. Shorter time to MRI/CT scan was associated with diffusion-perfusion mismatch in acute ischemic stroke patients.

Area of Science:

  • Neurology
  • Radiology
  • Emergency Medicine

Background:

  • Diffusion-perfusion mismatch on MRI can identify acute ischemic stroke patients eligible for thrombolysis beyond 3 hours.
  • Limited hospital availability of MRI necessitates exploring alternative imaging biomarkers.
  • Alberta Stroke Program Early CT Score (ASPECTS) and NIH Stroke Scale (NIHSS) are readily available clinical scores.

Purpose of the Study:

  • To investigate the correlation between ASPECTS-NIHSS mismatch and MRI diffusion-perfusion mismatch.
  • To determine if clinical scores can predict advanced imaging findings in acute ischemic stroke.

Main Methods:

  • Retrospective analysis of 143 acute ischemic stroke patients who underwent both CT and MRI.
  • NIHSS assessed by admitting physician; CT and MRI independently reviewed by blinded experts.

Related Experiment Videos

  • Diffusion-perfusion mismatch defined as >25% of the infarct core volume.

    • Main Results:

    • MRI diffusion-perfusion mismatch was present in 41% of patients.
    • No combination of NIHSS and ASPECTS thresholds significantly correlated with MRI mismatch.
    • Shorter time from stroke onset to imaging scan was the only factor associated with MRI mismatch (OR, 0.96 per hour).

    Conclusions:

    • ASPECTS-NIHSS mismatch does not reliably predict MRI diffusion-perfusion mismatch in acute ischemic stroke.
    • Time to imaging is a critical factor influencing the presence of diffusion-perfusion mismatch.
    • Clinical scores alone are insufficient to identify patients with advanced imaging findings for extended thrombolysis windows.