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(Stroke. 2007;38:1826.)
© 2007 American Heart Association, Inc.

Original Contributions

Evaluation of the Clinical–Diffusion and Perfusion–Diffusion Mismatch Models in DEFUSE

Maarten G. Lansberg, MD, PhD; Vincent N. Thijs, MD, PhD; Scott Hamilton, PhD; Gottfried Schlaug, MD; Roland Bammer, PhD; Stephanie Kemp, BS; Gregory W. Albers, MD on behalf of the DEFUSE Investigators

From Stanford Stroke Center, Stanford University Medical Center, Palo Alto, Calif (M.G.L., S.H., R.B., S.K., G.W.A.); Department of Neurology, University Hospitals of Leuven, Belgium (V.N.T.); Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston Mass (G.S.).

Correspondence to Maarten G. Lansberg, MD, PhD, Stanford University, Stanford Stroke Center, 701 Welch Road, Suite B 325, Palo Alto, CA 94304. E-mail Lansberg{at}stanford.edu

Background and Purpose— The perfusion–diffusion mismatch (PDM) model has been proposed as a tool to select acute stroke patients who are most likely to benefit from reperfusion therapy. The clinical–diffusion mismatch (CDM) model is an alternative method that is technically less challenging because it does not require perfusion-weighted imaging. This study is an evaluation of these 2 models in the DEFUSE dataset.

Methods— DEFUSE is an open-label multicenter study in which acute stroke patients were treated with intravenous tPA between 3 and 6 hours after symptoms onset and an MRI was obtained before and 3 to 6 hours after treatment. Presence of PDM and CDM was determined for each patient.

Results— Based on conventional predefined mismatch criteria, PDM was present in 54% of the DEFUSE population and CDM in 62%. There was no agreement beyond chance between the 2 mismatch models (kappa 0.07). The presence of PDM was associated with an increased chance of favorable clinical response after reperfusion (OR, 5.4; P=0.039). Reperfusion was not associated with a significant increase in the rate of favorable clinical response in patients with CDM (OR, 2.2; P=0.34). Using optimized mismatch criteria, determined retrospectively based on DEFUSE data, the OR for favorable clinical response was 70 (P=0.001) for PDM and 5.1 (P=0.066) for CDM.

Conclusion— The PDM model appears to be more accurate than the CDM model for selecting patients who are likely to benefit from reperfusion therapy in the 3- to 6-hour time window.

Key Words: acute treatment • diffusion-weighted MRI • ischemic stroke • outcome • plasminogen activator • perfusion-weighted MRI • reperfusion

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Mismatch and Defuse: Harvesting the Riches of Multicenter Neuroimaging-Based Stroke Studies

Chelsea S. Kidwell and Steven Warach
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