Brief Communication
Journal of Cerebral Blood Flow & Metabolism (2008) 28, 887–891; doi:10.1038/sj.jcbfm.9600604; published online 9 January 2008
Optimal definition for PWI/DWI mismatch in acute ischemic stroke patients
This article reports the results of a subanalysis of the DEFUSE study. The funding for the DEFUSE study was provided by NIH grants RO1 NS3 9325 and NS0 44848 to principal investigator, Gregory W Albers. The tissue plasminogen activator used in the study was provided by Genentech at no charge. Some of the authors have consulting relationships with Genentech or have received honoraria for lectures sponsored by Genentech, but none have any financial relationship with Genentech in excess of $10,000 per year. Vincent Thijs is supported by the Fonds voor Wetenschappelijk Onderzoek Vlaanderen and the Flanders Institute of Biotechnology.
Wataru Kakuda1, Maarten G Lansberg2, Vincent N Thijs3, Stephanie M Kemp2, Roland Bammer4, Lawrence R Wechsler5, Michael E Moseley4, Michael P Parks4 and Gregory W Albers2 on behalf of The DEFUSE Investigators
- 1Department of Rehabilitation Medicine, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- 2Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Palo Alto, California, USA
- 3Department of Neurology, University Hospital of Leuven, UZ Gasthuisberg, Leuven, Belgium
- 4Department of Radiology, Stanford Stroke Center, Stanford University Medical Center, Palo Alto, California, USA
- 5Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, Pittsburgh, Pennsylvania, USA
Correspondence: Dr W Kakuda, 3-19-18, Nishi-shimbashi, Minato-ku, Tokyo 105-8471, Japan. E-mail: wkakuda@jikei.ac.jp
Received 6 November 2007; Revised 29 November 2007; Accepted 30 November 2007; Published online 9 January 2008.
Abstract
Although the perfusion-weighted imaging/diffusion-weighted imaging (PWI/DWI) mismatch model has been proposed to identify acute stroke patients who benefit from reperfusion therapy, the optimal definition of a mismatch is uncertain. We evaluated the odds ratio for a favorable clinical response in mismatch patients with reperfusion compared with no reperfusion for various mismatch ratio thresholds in patients enrolled in the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. A mismatch ratio of 2.6 provided the highest sensitivity (90% ) and specificity (83% ) for identifying patients in whom reperfusion was associated with a favorable response. Defining mismatch with a larger PWI/DWI ratio may provide greater power for detecting beneficial effects of reperfusion.
Keywords:
mismatch, ischemic penumbra, thrombolysis, acute ischemic stroke, perfusion-weighted imaging, diffusion-weighted imaging
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