Optimal definition for PWI/DWI mismatch in acute ischemic stroke patients

被引:133
作者
Kakuda, Wataru [1 ]
Lansberg, Maarten G. [2 ]
Thijs, Vincent N. [3 ]
Kemp, Stephanie M. [2 ]
Bammer, Roland [4 ]
Wechsler, Lawrence R. [5 ]
Moseley, Michael E. [4 ]
Parks, Michael P. [4 ]
Albers, Gregory W. [2 ]
机构
[1] Jikei Univ, Sch Med, Dept Rehabil Med, Minato Ku, Tokyo 1058471, Japan
[2] Stanford Univ, Med Ctr, Stanford Stroke Ctr, Dept Neurol & Neurol Sci, Palo Alto, CA 94304 USA
[3] Univ Hosp Leuven, Dept Neurol, Louvain, Belgium
[4] Stanford Univ, Med Ctr, Stanford Stroke Ctr, Dept Radiol, Palo Alto, CA 94304 USA
[5] Univ Pittsburgh, Med Ctr, Stroke Inst, Dept Neurol, Pittsburgh, PA USA
关键词
mismatch; ischemic penumbra; thrombolysis; acute ischemic stroke; perfusion-weighted imaging; diffusion-weighted imaging;
D O I
10.1038/sj.jcbfm.9600604
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:887 / 891
页数:5
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