title: Diffusion-weighted imaging volume as the best predictor of the diffusion-perfusion mismatch in acute stroke patients within 8 hours of onset.
abstract: BACKGROUND
  Diagnostic accuracies of standard NCCT, CTA, CTA-SI, FLAIR, and DWI to detect the diffusion-perfusion mismatch (DPM) were compared.
  
  
  METHODS
  Stroke patients considered for endovascular therapy within 8 hours of onset were enrolled. DPM was defined as at least 160% mismatch between DWI and PWI volume.
  
  
  RESULTS
  DPM was seen in 35 (71%) of 49 patients. ASPECTS on NCCT, CTA-SI, and DWI was 9 (8-9), 8 (6-9), and 7 (5-9) in mismatch group, and 6 (4-9), 6 (2-7), 5 (2-6) in nonmismatch group, respectively (P = .027, .006, and .001). Ischemic volume on CTA-SI and DWI was 4.6 (.2-13.0) cm(3) and 21.5 (9.7-44.0) cm(3) in mismatch group, and 61.5 (6.6-101.1) cm(3) and 94.9 (45.7-139.8) cm(3) in nonmismatch group (P = .003 and <.001). Significant collateralization on CTA-SI and FLAIR was seen in 80% and 88% in mismatch group, and 42% and 58% in nonmismatch group (P = .026 and .039). Odds ratios (95% CI) of DWI volume of ≤ 70 cm(3) to predict the mismatch was 30.17 (2.06-442.41) after adjusting for ASPECTSs on NCCT, CTA-SI, and DWI, 44.90 (2.75-732.73) for ischemic volume on CTA-SI, and 42.80 (3.05-601.41) for significant collateralization on CTA-SI and FLAIR (P = .013, .008, and .005).
  
  
  CONCLUSIONS
  DWI volume was the best predictor of DPM.
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Ohio.
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Ohio.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tateishi
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Ohio.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Cummings
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Ohio.
authors.forename: Esteban
authors.initials: E
authors.lastname: Cheng-Ching
authors.affiliation: Neuroradiology, Imaging Institute, Cleveland Clinic, Ohio.
authors.forename: Paul
authors.initials: P
authors.lastname: Ruggieri
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Ohio.
authors.forename: Muhammad Shazam
authors.initials: MS
authors.lastname: Hussain
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Ohio.
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
mesh_terms: D000368:Aged; D003422:Critical Care / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Acute ischemic stroke; DWI/PWI mismatch; neuroimaging