title: Susceptibility-Diffusion Mismatch in Hyperacute Stroke: Correlation with Perfusion-Diffusion Mismatch and Clinical Outcome.
abstract: BACKGROUND
  A prominent vein (PV) on susceptibility-weighted imaging (SWI) was recently proposed to be a marker of the penumbra. We aimed to compare the utility of SWI and perfusion-weighted imaging (PWI) sequences for the evaluation of the penumbra in hyperacute middle cerebral artery (MCA) stroke, and to determine whether SWI-DWI mismatch is a neuroimaging marker of clinical outcome.
  
  
  METHODS
  A total of 149 consecutive patients with MCA stroke were prospectively enrolled. Magnetic resonance imaging (MRI) was performed within 6 hours of the onset of stroke. The ASPECTS values on diffusion-weighted imaging (DWI), PWI (delayed mean transit time), and SWI (visualization of PVs) were calculated by 2 independent raters. Correlation between PWI-ASPECTS and SWI-ASPECTS was calculated with the Pearson coefficient. Reliability of the PV rating system was calculated by an intraclass correlation coefficient (ICC). Favorable outcome was defined as a modified Rankin Scale score of 0-2 at 3 months for the 88 patients who received thrombolytic therapy.
  
  
  RESULTS
  The ASPECTS-SWI and ASPECTS-PWI scores showed a good correlation (Pearson coefficient of .69, P <.001). The reproducibility between the findings of the junior and the senior radiologists was excellent with an ICC of .89 (confidence interval of 95% (IC95): .85-.92, P <.001). However, neither SWI-DWI mismatch nor PWI-SWI mismatch was associated with clinical outcome.
  
  
  CONCLUSIONS
  SWI and PWI were complementary but not commutable for the assessment of the penumbra. Susceptibility-diffusion mismatch was not found in this study to have predictive value for stroke outcome.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Bretonneau University Hospital, Tours, France. Electronic address: maelle.d@hotmail.fr.
authors.forename: Maelle
authors.initials: M
authors.lastname: Dejobert
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Bretonneau University Hospital, Tours, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cazals
authors.affiliation: Department of Neurology, Bretonneau University Hospital, Tours, France.
authors.forename: Mariam
authors.initials: M
authors.lastname: Annan
authors.affiliation: Department of Neurology, Bretonneau University Hospital, Tours, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Debiais
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Bretonneau University Hospital, Tours, France.
authors.forename: Marie-Agnes
authors.initials: MA
authors.lastname: Lauvin
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Bretonneau University Hospital, Tours, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Cottier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002560:Cerebrovascular Circulation; D003287:Contrast Media / Q000008:administration & dosage; D038524:Diffusion Magnetic Resonance Imaging; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D007275:Injections, Intravenous; D008297:Male; D008536:Meglumine / Q000008:administration & dosage / Q000031:analogs & derivatives; D008875:Middle Aged; D015588:Observer Variation; D009942:Organometallic Compounds / Q000008:administration & dosage; D055420:Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine
keywords: Rankin scale; Susceptibility-weighted imaging; penumbra; prominent veins; stroke