Total Mismatch: Negative Diffusion-Weighted Imaging but Extensive Perfusion Defect in Acute Stroke

• Published in: Stroke (1970) 2009-10, Vol.40 (10), p.3400-3402
• Main Authors: CHO, Tae-Hee, HERMIER, Marc, ALAWNEH, Josef A, RITZENTHALER, Thomas, DESESTRET, Virginie, ØSTERGAARD, Leif, DEREX, Laurent, BARON, Jean-Claude, NIGHOGHOSSIAN, Norbert
• Format: Article
• Language: English
• Subjects: Acoustics; Adult; Aged; Bioengineering; Biological and medical sciences; Brain - blood supply; Brain - pathology; Brain - physiopathology; Brain Ischemia - drug therapy; Brain Ischemia - pathology; Brain Ischemia - physiopathology; Cerebral Arteries - drug effects; Cerebral Arteries - physiopathology; Cerebrovascular Circulation - drug effects; Cerebrovascular Circulation - physiology; Computer Science; Decision Support Techniques; Diagnostic Errors - prevention & control; Diffusion Magnetic Resonance Imaging - methods; Engineering Sciences; Female; Fibrinolytic Agents - administration & dosage; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hemodynamics - drug effects; Hemodynamics - physiology; Humans; Image Processing; Imaging; Life Sciences; Male; Mechanics; Medical Imaging; Medical Physics; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Nuclear medicine; Physics; Predictive Value of Tests; Sensitivity and Specificity; Severity of Illness Index; Signal and Image Processing; Stroke - drug therapy; Stroke - pathology; Stroke - physiopathology; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - administration & dosage; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.109.563064

The perfusion-weighted imaging (PWI)/diffusion-weighted imaging (DWI) mismatch may identify patients who benefit from thrombolysis. However, some patients exhibit a "total mismatch," ie, negative DWI but extensive PWI defect. We aimed to assess clinical and MRI data of these patients. From June 2007 to December 2008, patients with anterior circulation ischemic stroke were evaluated for a "total mismatch" profile. MRI was performed at admission and at day 1. The score was assessed at baseline and the modified Rankin scale score was assessed at day 30. Among 52 patients, 3 showed a total mismatch with arterial occlusion confirmed on magnetic resonance angiography. All had fluctuating symptoms (National Institutes of Health Stroke Scale scores, 0 to 10) and received intravenous tissue plasminogen activator. Day 1 DWI disclosed minimal changes in all patients. Outcome was favorable in all patients (day 30 modified Rankin scale, 0-1). PWI may be helpful for treatment decisions in patients without DWI damage and fluctuating clinical course.