Published online before print May 31, 2007, doi: 10.1161/STROKEAHA.107.488379
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(Stroke. 2007;38:2028.)
© 2007 American Heart Association, Inc.
Editorials |
CT/NIHSS Mismatch for Detection of Salvageable Brain in Acute Stroke Triage Beyond the 3-Hour Time Window
Overrated or Undervalued?
From the Division of Neuroradiology, Massachusetts General Hospital, and the Department of Radiology, Harvard Medical School, Boston, Mass.
Correspondence to Michael H. Lev, Division of Neuroradiology, Department of Radiology, Gray Building 241H, Massachusetts General Hospital, Fruit St, Boston, MA 02114. E-mail mlev@partners.org
Key Words: brain imaging • brain infarction • brain ischemia • CT • diffusion-weighted imaging • mismatch • neuroradiology
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
See related article, pages 2079–2084.
Although the only FDA-approved medical therapy for acute stroke to date remains intravenous tissue plasminogen activator administered within 3 hours of onset, there is increasing evidence that identification of potentially salvageable brain using advanced imaging may facilitate the selection of patients for safe and effective intravenous thrombolysis up to 9 hours postictus.1–5 Specifically, the mismatch between infarct core (brain likely to be irreversibly infarcted despite treatment) and ischemic penumbra (hypoperfused brain at risk for infarction in the absence of reperfusion) may identify patients with both a low hemorrhagic risk (small core) and a high likelihood of treatment benefit (large penumbra). In clinical practice, core can be operationally defined using either MR diffusion-weighted imaging (DWI) or CT cerebral blood volume imaging, and penumbra with either MR or CT perfusion-weighted imaging (PWI); conventional unenhanced CT provides a less sensitive measure of core.6–8 Because many sites do not currently have access to advanced CT and MR modalities, however, and not all patients are candidates for such scanning even when it is available, there has been interest in using the mismatch between CT hypodensity and clinical NIHSS as a surrogate for radiographic core/penumbra mismatch.
In this issue of Stroke, Messe et al9 report that, for a community-based cohort of acute stroke patients, CT/NIHSS mismatch "could not be validated as a means to identify ischemic penumbra as defined by MRI diffusion-perfusion mismatch." MRI mismatch (>25%) was present in 41% of 143 patients scanned 2.5 to 13.9 hours after
Related Article:
Stroke 2007 38: 2079-2084.
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  M. B. Maas, M. H. Lev, H. Ay, A. B. Singhal, D. M. Greer, W. S. Smith, G. J. Harris, E. Halpern, A. Kemmling, W. J. Koroshetz, et al. Collateral Vessels on CT Angiography Predict Outcome in Acute Ischemic Stroke Stroke, September 1, 2009; 40(9): 3001 - 3005. [Abstract] [Full Text] [PDF]
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M. B. Maas, K. L. Furie, M. H. Lev, H. Ay, A. B. Singhal, D. M. Greer, G. J. Harris, E. Halpern, W. J. Koroshetz, and W. S. Smith National Institutes of Health Stroke Scale Score Is Poorly Predictive of Proximal Occlusion in Acute Cerebral Ischemia Stroke, September 1, 2009; 40(9): 2988 - 2993. [Abstract] [Full Text] [PDF]
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P. W. Schaefer, E. R. Barak, S. Kamalian, L. R. Gharai, L. Schwamm, R. G. Gonzalez, and M. H. Lev Quantitative Assessment of Core/Penumbra Mismatch in Acute Stroke: CT and MR Perfusion Imaging Are Strongly Correlated When Sufficient Brain Volume Is Imaged Stroke, November 1, 2008; 39(11): 2986 - 2992. [Abstract] [Full Text] [PDF]
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