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(Stroke. 2008;39:2423.)
© 2008 American Heart Association, Inc.

Editorials

MRA/DWI Mismatch

A Novel Concept or Something One Could Get Easier and Cheaper?

Peter D. Schellinger, MD, PhD Martin Köhrmann, MD

From the Department of Neurology, University at Erlangen, Erlangen, Germany.

Correspondence to Peter D. Schellinger, MD, PhD, Department of Neurology, Schwabachanlage 6, D-91054 Erlangen, Germany. E-mail Peter.Schellinger@uk-erlangen.de

Key Words: diffusion-weighted imaging • MRI • thrombolysis

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

See related article, pages 2491–2496.

"Too much is never good; too little is never enough."

— —French proverb

Lansberg et al present a further subanalysis (QUOTE) of the DEFUSE study.¹ They assessed whether a more stringent "mismatch" concept than the usual perfusion imaging (PI)/diffusion-weighted imaging (DWI) mismatch would be a good tool to identify a target group, which might profit from early reperfusion enhanced by recombinant tissue plasminogen activator. In fact, they looked for patients with proximal middle cerebral artery occlusion or proximal stenosis with distal occlusion and a small DWI lesion (<25 mL respectively <15 mL). This of course is a smart thing to do, because the target group for treatment is further refined, albeit diminished in numbers. One could also increase the widely accepted mismatch ratio of 1.2 to 1.5, or 2.0, which would also optimize the target group at the cost of numbers of patients to be treated.

If the French proverb mentioned at the beginning of this Editorial were accurate, the MR angiography (MRA)/DWI mismatch idea would have some merit. Who exactly are these patients? In essence, they are patients with a therapeutic target (relevant vessel occlusion) and a very small tissue lesion at screening. One could also phrase it differently. These are patients with a very large perfusion deficit and a very small diffusion lesion. Of course, these patients are the optimum target group for recanalization/reperfusion approaches in a later time window and of course these patients have a benefit on reperfusion.

At what . . . [Full Text of this Article]

Related Article:

The MRA-DWI Mismatch Identifies Patients With Stroke Who Are Likely to Benefit From Reperfusion

Maarten G. Lansberg, Vincent N. Thijs, Roland Bammer, Jean-Marc Olivot, Michael P. Marks, Lawrence R. Wechsler, Stephanie Kemp, and Gregory W. Albers
Stroke 2008 39: 2491-2496. [Abstract] [Full Text] [PDF]

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