This Article Full Text Full Text (PDF) All Versions of this Article: 38/6/1718    most recent STROKEAHA.107.487215v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kidwell, C. S. Articles by Warach, S. Search for Related Content PubMed PubMed Citation Articles by Kidwell, C. S. Articles by Warach, S. Pubmed/NCBI databases Medline Plus Health Information MRI Scans Stroke Related Collections Acute Cerebral Infarction Computerized tomography and Magnetic Resonance Imaging Thrombolysis Related Article

(Stroke. 2007;38:1718.)
© 2007 American Heart Association, Inc.

Editorials

Mismatch and Defuse

Harvesting the Riches of Multicenter Neuroimaging-Based Stroke Studies

Chelsea S. Kidwell, MD Steven Warach, MD, PhD

From the Georgetown University (C.S.K.), Washington, DC; the Washington Hospital Center (C.S.K., S.W.), Washington, DC; and the National Institute of Neurological Disorders and Stroke (S.W.), National Institutes of Health, Bethesda, Md.

Correspondence to Chelsea S. Kidwell, MD, 110 Irving St NW, East Building Rm 6126, Washington, DC 20010. E-mail Ck256@georgetown.edu

See related article, pages 1826–1830.

Key Words: acute stroke • magnetic resonance • thrombolysis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The goal of acute stroke evaluation is to determine not only stroke type (ischemic versus hemorrhagic) and localization (anatomical and vascular), but perhaps more importantly, to determine reversibility (presence of an ischemic penumbra that may be salvaged with acute therapy). Traditionally, neurologists have relied on history and neurological examination to provide much of this information. However, long experience has demonstrated that the neurological examination is imperfect at best in determining lesion localization and grossly limited in its ability to provide insights into the presence of penumbral tissue. This is evidenced by the only modest correlations between National Institutes of Health Stroke Scale (NIHSS) score and perfusion-weighted imaging lesion volume.^1,2

The last decade has seen a striking growth in neuroimaging techniques that provide important real-time information about acute stroke pathophysiology. In the mid-1990s the advent of diffusion-weighted imaging revolutionized the role of MRI in acute stroke evaluation. Not only could diffusion-weighted imaging provide evidence of tissue injury within minutes of symptom onset, but also the diffusion-perfusion mismatch model offered a simple and practical means of identifying the ischemic penumbra and thus patients most likely to respond to reperfusion therapies, particularly in the late time window (>3 hours from symptom onset).³ Multiple prior studies have shown that if blood flow is not restored, the diffusion lesion will grow into the mismatch region and become a permanent infarct.⁴ Although this model continues to offer an imperfect approach to defining the penumbra, it has clearly been shown to provide a good approximation of penumbral . . . [Full Text of this Article]

Related Article:

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

Maarten G. Lansberg, Vincent N. Thijs, Scott Hamilton, Gottfried Schlaug, Roland Bammer, Stephanie Kemp, Gregory W. Albers on behalf of the DEFUSE Investigators
Stroke 2007 38: 1826-1830. [Abstract] [Full Text] [PDF]