Optimal definition for PWI/DWI mismatch in acute ischemic stroke patients.
Although the perfusion-weighted imaging/diffusion-weighted imaging (PWI/DWI) mismatch model has been proposed to identify acute stroke patients who benefit from reperfusion therapy, the optimal definition of a mismatch is uncertain. We evaluated the odds ratio for a favorable clinical response in mismatch patients with reperfusion compared with no reperfusion for various mismatch ratio thresholds in patients enrolled in the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. A mismatch ratio of 2.6 provided the highest sensitivity (90%) and specificity (83%) for identifying patients in whom reperfusion was associated with a favorable response. Defining mismatch with a larger PWI/DWI ratio may provide greater power for detecting beneficial effects of reperfusion.
Kakuda
Wataru
W
Department of Rehabilitation Medicine, Jikei University School of Medicine, Minato-ku, Tokyo, Japan. wkakuda@jikei.ac.jp
Lansberg
Maarten G
MG
Thijs
Vincent N
VN
Kemp
Stephanie M
SM
Bammer
Roland
R
Wechsler
Lawrence R
LR
Moseley
Michael E
ME
Marks
Michael P
MP
Parks
Michael P
MP
Albers
Gregory W
GW
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology* / Q000628:therapy; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000473:pathology* / Q000628:therapy; D015912:Thrombolytic Therapy