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Perfusion/Diffusion Mismatch Is Valid and Should Be Used for Selecting Delayed Interventions

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Abstract

The mismatch between a larger perfusion lesion and smaller diffusion lesion on magnetic resonance imaging is a validated signal of the ischemic penumbra, namely the region at risk in acute ischemic stroke that is critically hypoperfused and the target of reperfusion therapies. Clinical trials have shown strong correlations between reperfusion in mismatch patients and improved clinical outcomes. Attenuation of infarct growth is associated with reperfusion and corresponding clinical gains. Using computed tomography perfusion, the mismatch between relative cerebral blood flow or cerebral blood volume and perfusion delay is a comparable penumbral marker. Automated techniques allow rapid quantitative assessment of mismatch with thresholding to exclude benign oligemia. The penumbra is often present beyond the current 4.5-h time window, defined for the use of intravenous tPA. Treatment beyond this time point remains investigational. Although the efficacy of thrombolysis in mismatch patients requires further validation in randomized trials, there is now sufficient evidence to recommend that advanced neuroimaging of mismatch should be used for selection of delayed therapies in phase 3 trials.

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Conflicts of Interest

The authors declare that they have no relevant conflicts of interest.

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Authors and Affiliations

  1. Department of Medicine, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Melbourne, Victoria, 3050, Australia

    Stephen Davis, Bruce Campbell, Soren Christensen & Patricia Desmond

  2. Departments of Medicine and Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Melbourne, Victoria, Australia

    Stephen Davis, Bruce Campbell, Soren Christensen & Patricia Desmond

  3. Florey Neuroscience Institutes and University of Melbourne, Carlton South, 3053, Australia

    Henry Ma & Geoffrey Donnan

  4. Department of Neurosciences, Box Hill Hospital, Eastern Health, Monash University, Melbourne, Australia

    Christopher Bladin

  5. Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia

    Mark Parsons & Christopher Levi

  6. Centre for Brain Research, University of Auckland, Auckland, New Zealand

    P. Alan Barber

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  1. Stephen Davis
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  2. Bruce Campbell
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Correspondence to Stephen Davis.

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Davis, S., Campbell, B., Christensen, S. et al. Perfusion/Diffusion Mismatch Is Valid and Should Be Used for Selecting Delayed Interventions. Transl. Stroke Res. 3, 188–197 (2012). https://doi.org/10.1007/s12975-012-0167-8

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  • DOI: https://doi.org/10.1007/s12975-012-0167-8

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