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Updated: Mar 21, 2026
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A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
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Susceptibility-Diffusion Mismatch in Hyperacute Stroke: Correlation with Perfusion-Diffusion Mismatch and Clinical
Maelle Dejobert1, Xavier Cazals1, Mariam Annan2
1Department of Diagnostic and Interventional Neuroradiology, Bretonneau University Hospital, Tours, France.
Summary
Susceptibility-weighted imaging (SWI) and perfusion-weighted imaging (PWI) are complementary for assessing stroke penumbra but not interchangeable. SWI-DWI mismatch does not predict clinical outcomes in acute middle cerebral artery stroke.
Area of Science:
- Neuroimaging
- Radiology
- Stroke Research
Background:
- Prominent vein (PV) on susceptibility-weighted imaging (SWI) proposed as a penumbra marker.
- Evaluating SWI and perfusion-weighted imaging (PWI) for hyperacute middle cerebral artery (MCA) stroke penumbra assessment.
- Investigating SWI-DWI mismatch as a predictor of clinical outcome in stroke.
Purpose of the Study:
- Compare SWI and PWI utility in evaluating MCA stroke penumbra.
- Determine if SWI-DWI mismatch predicts clinical outcome.
- Assess the correlation and reliability of SWI and PWI ASPECTS scores.
Main Methods:
- Prospective enrollment of 149 MCA stroke patients within 6 hours of onset.
- MRI including DWI, PWI (delayed mean transit time), and SWI (PV visualization).
- Calculation of ASPECTS scores, correlation (Pearson), and reliability (ICC) for SWI and PWI.
Main Results:
- Good correlation between ASPECTS-SWI and ASPECTS-PWI (r=0.69, P<.001).
- Excellent inter-rater reliability for PV rating (ICC=0.89).
- Neither SWI-DWI nor PWI-SWI mismatch correlated with favorable clinical outcome.
Conclusions:
- SWI and PWI are complementary for penumbra assessment but not interchangeable.
- Susceptibility-diffusion mismatch lacks predictive value for stroke outcome in this cohort.
