Perfusion-diffusion Mismatch Predicts Early Neurological Deterioration in Anterior Circulation Infarction without Thrombolysis

Title:Perfusion-diffusion Mismatch Predicts Early Neurological Deterioration in Anterior Circulation Infarction without Thrombolysis

Volume: 12 Issue: 3

Author(s): Chia-Yu Hsu, Chun-Yu Cheng, Yuan-Hsiung Tsai, Jiann-Der Lee, Jen-Tsung Yang, Hsu-Huei Weng, Leng-Chieh Lin, Ying-Chih Huang, Meng Lee, Ming-Hsueh Lee, Chih-Ying Wu, Ya-Hui Lin, Huan-Lin Hsu, Hsin-Ta Yang, Yi-Ting Pan and Yen-Chu Huang

Affiliation:

Keywords: Early neurological deterioration, acute ischemic stroke, perfusion-diffusion mismatch.

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.

Cite this article as:

Hsu Chia-Yu, Cheng Chun-Yu, Tsai Yuan-Hsiung, Lee Jiann-Der, Yang Jen-Tsung, Weng Hsu-Huei, Lin Leng-Chieh, Huang Ying-Chih, Lee Meng, Lee Ming-Hsueh, Wu Chih-Ying, Lin Ya-Hui, Hsu Huan-Lin, Yang Hsin-Ta, Pan Yi-Ting and Huang Yen-Chu, Perfusion-diffusion Mismatch Predicts Early Neurological Deterioration in Anterior Circulation Infarction without Thrombolysis, Current Neurovascular Research 2015; 12 (3) . https://dx.doi.org/10.2174/1567202612666150605122536