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Relationship Between Magnetic Resonance Arterial Patency and Perfusion-Diffusion Mismatch in Acute Ischemic Stroke and Its Potential Clinical Use
Irina A. Staroselskaya, MD;
Claudia Chaves, MD;
Brian Silver, MD;
Italo Linfante, MD;
Robert R. Edelman, MD;
Louis Caplan, MD;
Steven Warach, MD, PhD;
Alison E. Baird, FRACP, PhD
Arch Neurol. 2001;58:1069-1074.
Background In patients with acute ischemic stroke the magnetic resonance (MR) perfusion-diffusion
mismatch pattern (perfusion lesion at least 20% larger than the lesion on
diffusion-weighted imaging) may indicate ischemically threatened but viable
tissue. To our knowledge, the relationship of this MR pattern to serial changes
in MR angiography (MRA) has not been reported.
Objectives To investigate the relationship between MRA changes and patterns of
diffusion-weighted imaging and perfusion abnormalities and to determine if
the information obtained could be used in clinical management.
Methods The MR studies of 35 patients who had undergone sequential multimodality
MR imaging studies within the first 4 days of stroke were reviewed. All lesions
were in the internal carotid artery territory distribution. Magnetic resonance
angiographies were read by 2 observers blinded to the clinical data.
Results During the first 24 hours a perfusion-diffusion mismatch was present
in 22 (92%) of the 24 patients with an MRA arterial occlusive lesion. (At
this time 5 [46%] of the 11 patients with a normal MRA [P = .006] also had a mismatch.) Two to 4 days after stroke, of these
22 patients resolution of the mismatch occurred in 8 (87%) of 9 patients with
recanalization on MRA compared with 5 (39%) of 13 patients without arterial
recanalization (P = .03). Resolution of mismatch
occurred in 3 (60%) of 5 patients with a normal MRA and a mismatch at the
first time point.
Conclusions Concordance between MRA and the MR perfusion-diffusion mismatch pattern
provides supportive evidence for an arterial vascular basis for this MR signature
in acute stroke. Discordance between MRA lesions and mismatch may result from
arterial branch occlusions undetected by MRA or from an alternate mechanism
for the mismatch. The MR imaging patterns identified extend our understanding
of the pathophysiology of stroke and may contribute to the improvement of
stroke management in the future.
From the Departments of Neurology (Drs Staroselskaya, Chaves, Linfante,
and Caplan) and Radiology (Dr Edelman), Beth Israel Deaconess Medical Center
and Harvard Medical School, Boston, Mass; London Health Sciences Centre, London,
Ontario (Dr Silver); and the National Institute of Neurological Disorders
and Stroke, Bethesda, Md (Drs Warach and Baird).
Corresponding author: Alison E. Baird, FRACP, PhD, National Institute
of Neurological Disorders and Stroke, National Institutes of Health, 36 Convent
Dr, MSC 4129, Room 4A03, Bethesda, MD 20892-4129 (e-mail: bairda{at}ninds.nih.gov).
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