NDLI: Fragmentation of the classical magnetic resonance mismatch 'penumbral' pattern with time.

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Fragmentation of the classical magnetic resonance mismatch 'penumbral' pattern with time.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Donnan, Geoffrey A. Zavala, Jorge A. Teoh, Hock Churilov, Leonid Phan, Thanh Wright, Peter Davis, Stephen M. Ma, Henry Ly, John Gunawan, Marveyles Arakawa, Shuji
Description	Country affiliation: Australia Author Affiliation: Ma H ( National Stroke Research Institute, Austin Health, University of Melbourne, 300 Waterdale Rd, Heidelberg West, Vic 3081, Australia.)
Abstract	BACKGROUND AND PURPOSE: The classical mismatch pattern in the middle cerebral artery territory stroke on MR is defined by a central diffusion-weighted image core with surrounding mismatch tissue. Because of variable rates of tissue salvage, we hypothesized that this pattern may fragment over time and may be influenced by vessel patency, mismatch volume, and infarct core location. METHODS: Patients were recruited with MR studies performed within 48 hours of ischemic stroke. Mismatch patterns based on diffusion-weighted/perfusion-weighted images were categorized as classical (majority of the diffusion-weighted image within the perfusion-weighted image lesion) or nonclassical (fragmented) patterns. The proportion of patterns was assessed with reference to time, vessel patency, mismatch volume, and infarct core location. RESULTS: Sixty-seven patients (33 classical [49.3%] and 34 nonclassical patterns [50.7%]) were studied within 48 hours (median age, 74.0 years). Compared to the nonclassical pattern, the classical pattern had a shorter time to MR (3.4 hours vs 10.4 hours; P=0.004) and a larger mismatch volume (62.0 mL vs 3.5 mL; P<0.0001). The positive predictors for the classical pattern were earlier time, vessel occlusion, superficial core location, and larger mismatch volume. CONCLUSIONS: The classical mismatch pattern may fragment with time. Over 48 hours the classical pattern is seen earlier after stroke onset, with higher rates of vessel occlusion and larger mismatch volumes.
ISSN	00392499
e-ISSN	15244628
Journal	Stroke
Issue Number	12
Volume Number	40
Language	English
Publisher	Lippincott Williams & Wilkins (on behalf of the American Heart Association)
Publisher Date	2009-12-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Brain Blood Supply Pathology Diffusion Magnetic Resonance Imaging Infarction, Middle Cerebral Artery Diagnosis Middle Cerebral Artery Physiopathology Brain Infarction Brain Ischemia Cohort Studies Disease Progression Image Processing, Computer-assisted Perfusion Imaging Predictive Value Of Tests Prognosis Sensitivity And Specificity Time Factors Research Support, Non-u.s. Gov't Discipline Cardiology
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine Neuroscience Advanced and Specialized Nursing Neurology (clinical)

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