Clinical-diffusion mismatch predicts the putative penumbra with high specificity
Clinical-diffusion mismatch predicts the putative penumbra with high specificity
复制标题
DOI：
10.1161/01.str.0000173407.40773.17
复制
发表时间：
2005-08-01
期刊：
影响因子：
8.3
通讯作者：
Davis, S
中科院分区：
文献类型：
--
作者：
Prosser, J;Butcher, K;Davis, S
Background and Purpose - Perfusion-diffusion (PWI-DWI) mismatch may represent the ischemic penumbra. The complexities associated with perfusion-weighted imaging (PWI) have restricted its use. Mismatch between stroke severity, assessed with the National Institutes of Health Stroke Scale (NIHSS), and the volume of the diffusion-weighted imaging (DWI) lesion (clinical-diffusion mismatch; CDM) has been suggested as a surrogate for PWI-DWI mismatch. We compared CDM with PWI and DWI in acute stroke.Methods - Seventy-nine hemispheric stroke patients were imaged within 24 hours of symptom onset and subacutely (3 to 5 days). CDM was defined as NIHSS >= 8 and DWI 20%). Early infarct expansion was calculated as DWIsubacute vol/DWIacute vol.Results - In the 54 sub-6-hour patients, CDM detected PWI-DWI mismatch with a specificity of 93% (95% confidence interval [CI], 62% to 99%), a positive predictive value of 95% (95% CI, 77% to 100%), but a sensitivity of only 53% (95% CI, 34% to 68%). Alternate DWI and NIHSS cutpoints did not improve test performance characteristics. In addition, subacute DWI expansion was significantly greater in patients with CDM (P = 0.01) compared with those without.Conclusions - CDM (NIH >= 8, DWI
