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(Stroke. 2007;38:2079.)
© 2007 American Heart Association, Inc.

Original Contributions

CT-NIHSS Mismatch Does Not Correlate With MRI Diffusion-Perfusion Mismatch

Steven R. Messé, MD; Scott E. Kasner, MD; Julio A. Chalela, MD; Brett Cucchiara, MD; Andrew M. Demchuk, MD; Michael D. Hill, MD Steven Warach, MD

From Department of Neurology (S.R.M., S.E.K., B.C.), University of Pennsylvania Medical Center, Philadelphia; Departments of Neurology and Neurosurgery (J.A.C.), Medical University of South Carolina, Charleston; Department of Clinical Neurosciences (A.M.D., M.D.H.), University of Calgary, Alberta, Canada; National Institutes of Health (S.W.), Bethesda, MD.

Correspondence to Steven R. Messé, MD, Department of Neurology, Comprehensive Stroke Center, University of Pennsylvania Medical Center, 3W Gates Building, 3400 Spruce Street, Philadelphia, PA 19104. E-mail messe{at}mail.med.upenn.edu

Background and Purpose— MRI diffusion-perfusion mismatch may identify patients for thrombolysis beyond 3 hours. However, MRI has limited availability in many hospitals. We investigated whether mismatch between the Alberta Stroke Program Early CT Score (ASPECTS) and the NIH Stroke Scale (NIHSS) correlates with MRI diffusion-perfusion mismatch.

Methods— We retrospectively analyzed a cohort of consecutive acute ischemic stroke patients who underwent MRI and CT at admission. NIHSS was performed by the admitting physician. MRI and CT were reviewed by 2 blinded expert raters. Degree of MRI mismatch was defined as present (> 25%) or absent (<25%). Univariate and multivariate analyses were performed to determine characteristics associated with MRI mismatch. Probability of MRI mismatch was calculated for all combinations of ASPECTS and NIHSS cutoff scores.

Results— Included in the analysis were 143 patients. Median NIHSS on admission was 4 (IQR, 2 to 10); median ASPECTS was 10 (IQR, 9 to 10). Median time to completion of MRI and CT was 4.5 (2.5 to 13.9) hours after onset. CT and MRI were separated by a median of 35 (IQR, 29 to 44) minutes. MRI mismatch was present in 41% of patients. In multivariate analysis, only shorter time-to-scan (OR, 0.96 per hour; 95% CI, 0.92 to 1.0; P=0.043) was associated with MRI mismatch. There was no combination of NIHSS and ASPECTS thresholds that was significantly associated with MRI mismatch.

Conclusions— ASPECTS-NIHSS mismatch did not correlate with MRI diffusion-perfusion mismatch in this clinical cohort. MRI mismatch was associated with decreasing time from stroke onset to scan.

Key Words: cerebral infarct • computed tomography • ischemic penumbra • magnetic resonance imaging • mismatch • neuroradiology • thrombolysis

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