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(Stroke. 2003;34:1681.)
© 2003 American Heart Association, Inc.

Original Contributions

Reliability of Assessing Percentage of Diffusion-Perfusion Mismatch

Shelagh B. Coutts, MBChB; Jessica E. Simon, MBChB; Anna I. Tomanek, MD; Philip A. Barber, MBChB; Jean Chan, MD; Mark E. Hudon, MD; J. Ross Mitchell, PhD; Richard Frayne, PhD; Michael Eliasziw, PhD; Alastair M. Buchan, MD Andrew M. Demchuk, MD

From the Seaman Family MR Research Centre, Foothills Medical Centre, Calgary Health Region (S.B.C., J.E.S., A.I.T., J.R.M., R.F., A.M.D.), and Departments of Clinical Neurosciences (S.B.C., J.E.S., A.I.T., P.A.B., M.E.H., J.R.M., R.F., M.E., A.M.B., A.M.D.), Community Health Sciences (M.E.), and Radiology (J.C., M.E.H., J.R.M., R.F.), University of Calgary, Calgary, Alberta, Canada.

Correspondence to Dr Shelagh Coutts, Seaman Family MR Centre, Foothills Hospital, 1403 29th St NW, Calgary, Alberta T2N 2T9, Canada. E-mail shelagh.coutts{at}calgaryhealthregion.ca

Background and Purpose— Emergent neurovascular imaging holds promise in identifying new and optimum target populations for thrombolysis in stroke. Recent research has focused on patients with diffusion-weighted MRI (DWI)-perfusion-weighted MRI (PWI) mismatch as a marker of tissue at risk of infarction and a means to select the most suitable candidates for thrombolysis. The present study sought to estimate the reliability of assessing the percentage of DWI-PWI mismatch.

Methods— Thirteen patients with acute strokes had DWI and PWI within 7 hours of symptom onset. Six raters independently created relative mean transit time (rMTT) maps and then compared them with DWI images to assess the percentage of mismatch (PWI>DWI) in 10% increments. The MR scans were reassessed by 4 raters, tracing around the lesions to calculate the volume percentage of mismatch.

Results— Visual assessment had an interrater reliability of 0.68 (95% CI, 0.52 to 1.0; SEM=21.6%) and an intrarater reliability of 0.80 (95% CI, 0.47 to 1.0; SEM=16.9%). Hand-drawn assessment had an interrater reliability of 0.66 (95% CI, 0.45 to 1.0; SEM=26.2%) and an intrarater reliability of 0.94 (95% CI, 0.81 to 1.0; SEM=10.9%).

Conclusions— Results from the present study suggest that quantifying mismatch by the human eye is reproducible but not reliable among observers. This raises doubts about using mismatch for clinical decision making and clinical trial enrollment.

Key Words: magnetic resonance imaging, diffusion-weighted • magnetic resonance imaging, perfusion-weighted • penumbra • stroke, acute

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