Published Online
on May 31, 2007

A more recent version of this article appeared on July 1, 2007

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Submitted on December 19, 2006
Revised on February 16, 2007
Accepted on March 8, 2007

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; and 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.

^* To whom correspondence should be addressed. 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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