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(Stroke. 2009;40:3400.)
© 2009 American Heart Association, Inc.

Research Letters

Total Mismatch

Negative Diffusion-Weighted Imaging but Extensive Perfusion Defect in Acute Stroke

Tae-Hee Cho, MD; Marc Hermier, MD, PhD; Josef A. Alawneh, MRCP; Thomas Ritzenthaler, MD; Virginie Desestret, MD; Leif Østergaard, MD, PhD; Laurent Derex, MD, PhD; Jean-Claude Baron, MD, FRCP, FMedSci Norbert Nighoghossian, MD, PhD

From Cerebrovascular Unit (T.-H.C., T.R., V.D., L.D., N.N.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; Creatis-LRMN (T.-H.C., M.H., T.R., V.T., L.D., N.N.), UMR 5520-Inserm 630, Claude Bernard Lyon 1 University; Neuroradiology Department (M.H.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; Stroke Research Group (J.A.A., J.-C.B.), Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; Center of Functionally Integrative Neuroscience (L.O.), Aarhus University Hospital, University of Aarhus.

Correspondence to N. Nighoghossian, Hôpital Neurologique Pierre Wertheimer, 59 Bd Pinel 69777 Bron. E-mail norbert.nighoghossian{at}chu-lyon.fr

Background and Purpose— The perfusion-weighted imaging (PWI)/diffusion-weighted imaging (DWI) mismatch may identify patients who benefit from thrombolysis. However, some patients exhibit a "total mismatch," ie, negative DWI but extensive PWI defect. We aimed to assess clinical and MRI data of these patients.

Methods— From June 2007 to December 2008, patients with anterior circulation ischemic stroke were evaluated for a "total mismatch" profile. MRI was performed at admission and at day 1. The score was assessed at baseline and the modified Rankin scale score was assessed at day 30.

Results— Among 52 patients, 3 showed a total mismatch with arterial occlusion confirmed on magnetic resonance angiography. All had fluctuating symptoms (National Institutes of Health Stroke Scale scores, 0 to 10) and received intravenous tissue plasminogen activator. Day 1 DWI disclosed minimal changes in all patients. Outcome was favorable in all patients (day 30 modified Rankin scale, 0–1).

Conclusion— PWI may be helpful for treatment decisions in patients without DWI damage and fluctuating clinical course.

Key Words: mismatch • MRI • stroke • thrombolysis