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(Stroke. 2003;34:1683.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Mismatch or Misconception?

Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts

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

The clinical utility of diffusion weighted MRI for assessing acute stroke patients has been known for some time.¹ The combination of diffusion- and perfusion-weighted imaging (using dynamic MRI to follow an intravenous bolus injection of contrast agent) has been shown to be valuable for predicting infarct growth by defining the mismatch between the lesion volume defined by diffusion imaging and that defined by abnormal blood flow or volume (the so-called diffusion-perfusion mismatch²). There have been numerous published studies, both in human patients and in various animal stroke models, supporting the use of diffusion- and perfusion-weighted MRI for characterizing acute stroke lesions and predicting lesion progression and eventual stroke outcome. As a result, diffusion/perfusion MRI has already become a part of the clinical decision-making process for acute stroke at many sites, and has also made its way into clinical trial design. With this in mind, it is rather surprising that little work has been done to measure the reliability of these techniques in the clinical setting. This article by Coutts et al addresses this issue by comparing estimates of the diffusion/perfusion mismatch, as determined by 6 individuals, in a group of acute stroke patients.

Coutts et al sound an important note of caution when interpreting such MRI data. They have shown that operator-defined measurements of the diffusion/perfusion mismatch in acute stroke patients are quite reproducible for any given individual but that interobserver reliability is rather poor. As they point out, this has serious implications when such measurements are determining the . . . [Full Text of this Article]