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Published on: November 19, 2020
Perfusion-diffusion Mismatch Predicts Early Neurological Deterioration in Anterior Circulation Infarction without
Chia-Yu Hsu, Chun-Yu Cheng, Yuan-Hsiung Tsai
1Department of Neurology, Chang Gung Memorial Hospital, 6 West Chia-Pu Road, Putz City, Chiayi County, Taiwan. yenchu.huang@msa.hinet.net.
Abstract:
Perfusion-diffusion mismatch in magnetic resonance imaging (MRI) represents the non-core hypoperfused area in acute ischemic stroke. The mismatch has been used to predict clinical response after thrombolysis in acute ischemic stroke, but its role for predicting early neurological deterioration (END) in acute ischemic stroke without thrombolysis has not been clarified yet. In this study, we prospectively recruited 54 patients with acute non-lacunar ischemic stroke in anterior circulation without thrombolysis. All patients received the first perfusion MRI within 24 hours from stroke onset. Target mismatch profile was defined as a perfusion-diffusion mismatch ratio ≥ 1.2. END was defined as an increase of ≥ 4 points in the National Institute of Health Stroke Scale (NIHSS) score within 72 hours. There were 13 (24.1%) patients developing END, which was associated with larger infarct growth (p = 0.002), worse modified Rankin Scale (p = 0.001) and higher mortality rate at 3 months (p = 0.025). Target mismatch profiles measured by T(max) ≥ 4, 5 and 6 seconds were independent predictors for END after correcting initial NIHSS score. Among the 3 T(max) thresholds, target mismatch measured by T(max) ≥ 6 seconds had the highest odd's ratio in predicting END (p < 0.01, odd's ratio = 17), with an 80% sensitivity and a 79.5% specificity. In conclusion, perfusion-diffusion mismatch could identify the patients at high risk of early clinical worsening in acute ischemic stroke without thrombolysis.
Insights
Perfusion-diffusion mismatch on MRI can predict early neurological deterioration in acute ischemic stroke patients not receiving thrombolysis. A mismatch ratio ≥ 1.2, particularly with Tmax ≥ 6 seconds, identifies high-risk individuals.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Perfusion-diffusion mismatch in acute ischemic stroke (AIS) identifies hypoperfused tissue.
- Its utility in predicting early neurological deterioration (END) in AIS without thrombolysis remains unclear.
- Early identification of END risk is crucial for patient management.
Purpose of the Study:
- To investigate the role of perfusion-diffusion mismatch in predicting END in AIS patients treated without thrombolysis.
- To determine the optimal Tmax threshold for predicting END.
Main Methods:
- Prospective study of 54 AIS patients without thrombolysis, receiving perfusion MRI within 24 hours.
- Target mismatch profile defined as mismatch ratio ≥ 1.2.
- END defined as ≥ 4-point NIHSS increase within 72 hours.
Main Results:
- 13 (24.1%) patients developed END, associated with larger infarct growth and worse outcomes.
- Target mismatch profiles (Tmax ≥ 4, 5, 6s) independently predicted END.
- Tmax ≥ 6 seconds showed the highest predictive value (OR=17, 80% sensitivity, 79.5% specificity).
Conclusions:
- Perfusion-diffusion mismatch is a valuable tool for identifying AIS patients at high risk of END.
- The Tmax ≥ 6 seconds threshold offers significant predictive power for clinical worsening.
- This finding aids in risk stratification for AIS patients ineligible for thrombolysis.
