Susceptibility-diffusion mismatch predicts thrombolytic outcomes: a retrospective cohort study

Area of Science:

• Neuroimaging
• Cerebrovascular Diseases
• Medical Diagnostics

Background:

• Asymmetric hypointensity of cerebral veins on SWI suggests hypoxia post-ischemia.
• SWI-DWI mismatch may indicate salvageable brain tissue in ischemic stroke.

Purpose of the Study:

• To determine if prominent SWI-DWI mismatch predicts better outcomes with thrombolytic therapy.
• To assess the utility of SWI-DWI mismatch in identifying stroke patients who benefit from reperfusion treatments.

Main Methods:

• Retrospective analysis of ischemic stroke patients receiving thrombolysis.
• Defined SWI-DWI mismatch using asymmetry index (≥1.75) and DWI lesion volume (≤25 mL).
• Logistic regression analyzed the association between mismatch profile and favorable outcome (modified Rankin Scale 0-2 at 3 months).

Main Results:

• Patients with SWI-DWI mismatch had significantly higher favorable outcome rates (78% vs. 44%; aOR=6.317, P=.037).
• Mismatch group showed improved outcomes with reperfusion (91% vs. 43%, P=.033) and recanalization (100% vs. 40%, P=.013).
• SWI-DWI mismatch demonstrated higher accuracy (63%) than perfusion-diffusion mismatch (48.1%) in predicting favorable outcomes.

Conclusions:

• SWI-DWI mismatch is a valuable imaging biomarker for identifying ischemic stroke patients who benefit from early reperfusion therapy.
• This imaging approach can aid in selecting appropriate candidates for thrombolytic treatment.