title: Association between the perfusion/diffusion and diffusion/FLAIR mismatch: data from the AXIS2 trial.
abstract: The perfusion-/diffusion-weighted imaging (PWI/DWI) mismatch and the diffusion/fluid attenuated inversion recovery (DWI/FLAIR) mismatch are magnetic resonance imaging (MRI) markers of evolving brain ischemia. We examined whether the DWI/FLAIR mismatch was independently associated with the PWI/DWI mismatch. Furthermore, we determined whether the presence of the DWI/FLAIR mismatch in patients with the PWI/DWI mismatch would provide additional information regarding last seen normal time (LTM). We used data from the 'AX200 for ischemic stroke' trial (AXIS 2 study NCT00927836). We studied the association between the presence of the DWI/FLAIR and PWI/DWI mismatch, baseline National Institute of Health Stroke Scale (NIHSS), age, ischemic-core volume, gender, intravenous (IV) tissue plasminogen activator (tPA), and perfusion-mismatch volume in univariate analysis. Significant variables (P<0.05) were added into the final multivariate model. We analyzed 197 patients. Seventy-two (37%) had both the PWI/DWI and the DWI/FLAIR mismatch. Patients with the double mismatch pattern had a shorter LTM than patients with the PWI/DWI mismatch alone (Median difference 90 minutes, P<0.01). Multivariate analysis confirmed the independent association between the two mismatch patterns (odds ratio (OR) 2.6, 95% confidence interval (CI) 1.2 to 5.4). Our study implies that the DWI/FLAIR mismatch and PWI/DWI mismatch are strongly associated, independent from LTM. Furthermore, in the presence of the PWI/DWI mismatch, the DWI/FLAIR pattern indicates a shorter LTM. This could have implications in selecting patients for reperfusion therapy.
authors.affiliation: Department of Neurosciences and Experimental Neurology, KULeuven, Leuven, Belgium.
authors.forename: Anke
authors.initials: A
authors.lastname: Wouters
authors.affiliation: Laboratory for Cognitive Neurology, Division of Experimental Neurology, Department of Neurosciences, KULeuven, Leuven, Belgium.|Medical Imaging Research Center, KULeuven, Leuven, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dupont
authors.affiliation: Department of Neurology, University of Münster, Münster, Germany.
authors.forename: Erich B
authors.initials: EB
authors.lastname: Ringelstein
authors.affiliation: Section of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.affiliation: Stroke Centre, University of Barcelona, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Chamorro
authors.affiliation: Kreisklinikum Siegen GmbH, Klinik für Neurologie, Siegen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Grond
authors.affiliation: GUIDED Development Heidelberg GmbH, Heidelberg, Germany.
authors.forename: Rico
authors.initials: R
authors.lastname: Laage
authors.affiliation: Sygnis Bioscience, Molecular Neurology, Heidelberg, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Guido
authors.initials: G
authors.lastname: Wilms
authors.affiliation: UKE Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Hamburg, Germany.
authors.forename: Götz
authors.initials: G
authors.lastname: Thomalla
authors.affiliation: Department of Neurosciences and Experimental Neurology, KULeuven, Leuven, Belgium.|Department of Neurology, University Hospitals Leuven, Leuven, Belgium.|Laboratory of Neurobiology, Vesalius Research Center, KULeuven, Leuven, Belgium.
authors.forename: Robin
authors.initials: R
authors.lastname: Lemmens
authors.affiliation: Department of Neurology, University Hospitals Leuven, Leuven, Belgium.|Laboratory of Neurobiology, Vesalius Research Center, KULeuven, Leuven, Belgium.
authors.forename: Vincent N
authors.initials: VN
authors.lastname: Thijs
mesh_terms: D000368:Aged; D002560:Cerebrovascular Circulation; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D020521:Stroke / Q000473:pathology*