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(Stroke. 2005;36:980.)
© 2005 American Heart Association, Inc.

Original Contributions

Does the Mismatch Match the Penumbra?

Magnetic Resonance Imaging and Positron Emission Tomography in Early Ischemic Stroke

Jan Sobesky, MD; Olivier Zaro Weber, MD; Fritz-Georg Lehnhardt, MD; Volker Hesselmann, MD; Michael Neveling, MD; Andreas Jacobs, MD Wolf-Dieter Heiss, MD

From Max Planck Institute for Neurological Research (J.S., O.Z.W., A.J., W.-D.H.), Cologne, Germany; Department of Neurology (J.S., O.Z.W., F.-G.L., M.N., A.J., W.-D.H.) and Department of Diagnostic Radiology (V.H.), University of Cologne, Germany.

Correspondence to Dr Jan Sobesky, Department of Neurology, University of Cologne, Josef Stelzmannstr. 9, 50924 Köln, Germany. E-mail j.sobesky{at}pet.mpin-koeln.mpg.de

Background and Purpose— In ischemic stroke, diffusion-weighted (DW) and perfusion-weighted (PW) magnet resonance imaging (MRI) is used to define the mismatch as the therapeutic target. With positron emission tomography (PET), we characterized the metabolic patterns of tissue compartments identified by MRI and compared the volumes of mismatch to those of PET-defined penumbra.

Methods— In 6 acute (median, 5.2 hours) and 7 chronic (median, 10 days) stroke patients in whom a mismatch was defined by PW/DW MRI, PET was performed (median, 120-minute delay). Cerebral blood flow (CBF), oxygen metabolism (CMRO₂), and oxygen extraction fraction (OEF) was determined in the areas of DWI lesion, mismatch, and oligemia. Then, the mismatch volume was compared with the volume of penumbra.

Results— DWI lesions showed impaired tissue integrity (low CMRO₂ and low OEF). Mismatch areas were viable (normal CMRO₂) but showed largely varying OEF. Oligemic areas had metabolic patterns comparable to normal tissue. A mismatch volume was found in all 13 patients. However, only 8 of 13 had a corresponding penumbra volume that covered only a part of the mismatch.

Conclusion— Our comparative PET/MRI study confirmed the current pathophysiological hypothesis for the DWI lesion and for the oligemic areas. However, the mismatch area did not reliably detect elevated OEF and overestimated the penumbra defined by PET.

Key Words: cerebral blood flow • magnetic resonance imaging • perfusion • stroke, acute • tomography, emission computed

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