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Updated: May 28, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Magnetic resonance angiography-diffusion mismatch reflects diffusion-perfusion mismatch in patients with hyperacute
Ichiro Deguchi1, Tomohisa Dembo, Takuya Fukuoka
1Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University, Saitama, Japan.
Background:
We evaluated whether clinical-diffusion mismatch (CDM) or magnetic resonance angiography (MRA)-diffusion mismatch (MDM) is useful in detecting diffusion-perfusion mismatch (DPM) in hyperacute cerebral infarction within 3 hours after stroke onset.
Methods:
Among patients with cerebral infarction who arrived within 3 hours after stroke onset at our hospital between May 2007 and December 2010, we included 21 patients (16 men and 5 women; mean age 70 ± 7.8 years) with cerebral infarction of the anterior circulation, and in whom magnetic resonance imaging (diffusion-weighted imaging)/MRA and computed tomograpic perfusion of the head were performed at the time of arrival. DPM-positive status was defined as a difference between DWI abnormal signal area and mean transit time prolongation area (≥ 20% on visual assessment). CDM-positive status was defined as a National Institute of Health Stroke Scale score ≥ 8 and DWI-Alberta Stroke Program Early CT Score (ASPECTS) ≥ 8. MDM-positive status was defined as a major artery lesion and DWI-ASPECTS ≥ 6.
Results:
Ten of 21 patients had DPM. In all DPM-positive patients, MRA revealed a major artery lesion. Of the 10 DPM-positive patients, 6 were CDM-positive. CDM detected DPM with a sensitivity of 60% and a specificity of 64%. The positive likelihood ratio was 1.65. Of the 10 DPM-positive patients, all were MDM-positive. MDM detected DPM with a sensitivity of 100% and a specificity of 82%. The positive likelihood ratio was 5.5.
Conclusions:
In hyperacute cerebral infarction within 3 hours after onset, MDM, as compared with CDM, was able to detect DPM with higher sensitivity and specificity. This suggests that MDM is more reflective of DPM.
Insights
Magnetic resonance angiography-diffusion mismatch (MDM) is more effective than clinical-diffusion mismatch (CDM) for detecting diffusion-perfusion mismatch (DPM) in acute stroke patients. MDM demonstrated higher sensitivity and specificity in identifying DPM within 3 hours of stroke onset.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Hyperacute cerebral infarction requires rapid and accurate diagnosis.
- Identifying diffusion-perfusion mismatch (DPM) is crucial for timely treatment decisions.
- Clinical-diffusion mismatch (CDM) and magnetic resonance angiography-diffusion mismatch (MDM) are potential imaging biomarkers.
Purpose of the Study:
- To evaluate the utility of CDM and MDM in detecting DPM in patients with hyperacute cerebral infarction.
- To compare the sensitivity and specificity of CDM and MDM for DPM detection within 3 hours of stroke onset.
Main Methods:
- Retrospective analysis of 21 patients with anterior circulation cerebral infarction within 3 hours of onset.
- Inclusion of patients who underwent diffusion-weighted imaging (DWI)/MRA and computed tomographic perfusion.
- Definition of DPM-positive status based on DWI and mean transit time (MTT) imaging.
- Definition of CDM-positive status based on NIH Stroke Scale and DWI-Alberta Stroke Program Early CT Score (ASPECTS).
- Definition of MDM-positive status based on major artery lesion and DWI-ASPECTS.
Main Results:
- Ten of 21 patients (47.6%) had DPM.
- All DPM-positive patients had a major artery lesion on MRA.
- MDM detected DPM with 100% sensitivity and 82% specificity.
- CDM detected DPM with 60% sensitivity and 64% specificity.
- MDM showed a higher positive likelihood ratio (5.5) compared to CDM (1.65).
Conclusions:
- MDM is more sensitive and specific than CDM in detecting DPM in hyperacute cerebral infarction.
- MDM appears to be a more reliable imaging marker for DPM in the early hours of stroke.
- These findings support the use of MDM for improved diagnosis and management of acute ischemic stroke.
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