NDLI: Perfusion–Diffusion Mismatch: Does It Identify Who Will Benefit from Reperfusion Therapy?

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Translational Stroke Research : Volume 3, Issue 1, March 2012

Translational Stroke Research : Volume 2

Translational Stroke Research : Volume 1

Perfusion–Diffusion Mismatch: Does It Identify Who Will Benefit from Reperfusion Therapy?

Content Provider	Springer Nature Link
Author	Powers, William J.
Copyright Year	2012
Abstract	A method to determine which patients would benefit from reperfusion therapies after 4.5 h would greatly add to our ability to reduce the disability caused by stroke. The goal of magnetic resonance perfusion–diffusion imaging in hyperacute ischemic stroke is to identify regions of the brain that will die if untreated and will live and regain function if quickly reperfused. The clinical value of perfusion–diffusion imaging in hyperacute ischemic stroke can be proven only by demonstrating empirically in a randomized controlled trial (RCT) that there is an improvement in patient outcome that depends on the use of the neuroimaging modality to guide therapy. To date, there have been only a few RCTs that have evaluated whether perfusion–diffusion imaging can identify a subgroup of patients with ischemic stroke more than 4.5 h from onset in whom the overall benefit from reperfusion therapy outweighs the risk. None have met the rigorous design requirements of the three-group study necessary to adequately test this hypothesis, and none have even met their own criteria for demonstrating a clinical benefit. While studies are not sufficient to conclusively disprove the hypothesis there are no RCT data to support it, and thus, the clinical value of MRI perfusion–diffusion imaging in this setting remains unproven. It is worthy of further investigation in rigorously designed RCTs. However, the risks of symptomatic intracerebral hemorrhage with reperfusion therapies in acute ischemic stroke are proven. Unless RCT data are forthcoming to demonstrate that MRI perfusion–diffusion mismatch improves clinical outcome, it should not be used to guide delayed reperfusion therapy.
Starting Page	182
Ending Page	187
Page Count	6
File Format	PDF
ISSN	18684483
Journal	Translational Stroke Research
Volume Number	3
Issue Number	2
e-ISSN	1868601X
Language	English
Publisher	Springer-Verlag
Publisher Date	2012-04-04
Publisher Place	New York
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Magnetic resonance Diffusion Perfusion Vascular Surgery Neurosurgery Cardiology Neurology Neurosciences
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine Neuroscience Neurology (clinical)

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Perfusion–Diffusion Mismatch: Does It Identify Who Will Benefit from Reperfusion Therapy?

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