title: Perfusion-diffusion Mismatch Predicts Early Neurological Deterioration in Anterior Circulation Infarction without Thrombolysis.
abstract: Perfusion-diffusion mismatch in magnetic resonance imaging (MRI) represents the non-core hypoperfused area in acute ischemic stroke. The mismatch has been used to predict clinical response after thrombolysis in acute ischemic stroke, but its role for predicting early neurological deterioration (END) in acute ischemic stroke without thrombolysis has not been clarified yet. In this study, we prospectively recruited 54 patients with acute non-lacunar ischemic stroke in anterior circulation without thrombolysis. All patients received the first perfusion MRI within 24 hours from stroke onset. Target mismatch profile was defined as a perfusion-diffusion mismatch ratio ≥ 1.2. END was defined as an increase of ≥ 4 points in the National Institute of Health Stroke Scale (NIHSS) score within 72 hours. There were 13 (24.1%) patients developing END, which was associated with larger infarct growth (p = 0.002), worse modified Rankin Scale (p = 0.001) and higher mortality rate at 3 months (p = 0.025). Target mismatch profiles measured by T(max) ≥ 4, 5 and 6 seconds were independent predictors for END after correcting initial NIHSS score. Among the 3 T(max) thresholds, target mismatch measured by T(max) ≥ 6 seconds had the highest odd's ratio in predicting END (p < 0.01, odd's ratio = 17), with an 80% sensitivity and a 79.5% specificity. In conclusion, perfusion-diffusion mismatch could identify the patients at high risk of early clinical worsening in acute ischemic stroke without thrombolysis.
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Hsu
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Cheng
authors.forename: Yuan-Hsiung
authors.initials: YH
authors.lastname: Tsai
authors.forename: Jiann-Der
authors.initials: JD
authors.lastname: Lee
authors.forename: Jen-Tsung
authors.initials: JT
authors.lastname: Yang
authors.forename: Hsu-Huei
authors.initials: HH
authors.lastname: Weng
authors.forename: Leng-Chieh
authors.initials: LC
authors.lastname: Lin
authors.forename: Ying-Chih
authors.initials: YC
authors.lastname: Huang
authors.forename: Meng
authors.initials: M
authors.lastname: Lee
authors.forename: Ming-Hsueh
authors.initials: MH
authors.lastname: Lee
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Wu
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Lin
authors.forename: Huan-Lin
authors.initials: HL
authors.lastname: Hsu
authors.forename: Hsin-Ta
authors.initials: HT
authors.lastname: Yang
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Pan
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital, 6 West Chia-Pu Road, Putz City, Chiayi County, Taiwan. yenchu.huang@msa.hinet.net.
authors.forename: Yen-Chu
authors.initials: YC
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000150:complications*; D038524:Diffusion Magnetic Resonance Imaging; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology*; D055420:Perfusion Imaging; D011237:Predictive Value of Tests; D012189:Retrospective Studies