Article Figures & Data
Figures
- Fig 1.
Illustrative case of FVH-DWI and PWI-DWI mismatch. MR images (A–D) of a 67-year-old man obtained 86 minutes after sudden onset of aphasia. Small hyperintense lesions are visible in the left MCA territory on admission DWI (A), with FVHs on FLAIR (B), some facing the DWI lesion (yellow arrows) and others located beyond the boundaries of DWI signal changes (red arrows), indicating a FVH-DWI mismatch. A large PWI-DWI mismatch on the Tmax map (C) with areas of Tmax of >6 seconds (yellow-to-red) topographically congruent with the FVHs. Proximal occlusion of left MCA on MRA (D, frontal view). On 24-hour follow-up MR images (E and F), there was no extension of the initial DWI lesion (E) and complete recanalization (F). IV-tPA was initiated 120 minutes after stroke onset.
- Fig 2.
Illustrative case of no FVH-DWI or PWI-DWI mismatch. MR imaging (A–D) of a 47-year-old man obtained 81 minutes after sudden onset of right hemiparesis. Large hyperintense lesions in the left MCA territory on admission DWI (A) with FVH on FLAIR (B, arrow) only overlying the hyperintense parenchyma on DWI, indicating the absence of FVH-DWI mismatch. C, No significant PWI-DWI mismatch on the Tmax map is seen. Note proximal occlusion of the left MCA on MRA (D, frontal view). On 24-hour follow-up MR images (E and F), extension of the initial DWI lesion (E) is seen despite recanalization (F). IV-tPA was initiated 105 minutes after stroke onset.
Tables
Univariate comparisons among patients according to FVH-DWI mismatch (n = 141)a
FVH-DWI Mismatch (n = 102) No FVH-DWI Mismatch (n = 39) P Value Demographics/risk factors Age (yr) 68 ± 15 68 ± 14 .86 Male 51 (50%) 23 (59%) .34 Hypertension 53 (52%) 23 (59%) .46 Diabetes mellitus 6 (6%) 7 (18%) .03 Hyperlipidemia 35 (34%) 15 (38%) .65 Smoking 37 (36%) 11 (28%) .37 Characteristics at admission Systolic BP (mm Hg) 153 ± 24 158 ± 18 .31 Diastolic BP (mm Hg) 83 ± 18 83 ± 17 .89 Serum glucose level (mmol/L) 6.8 ± 1.6 7.5 ± 1.9 .02 Initial NIHSS score 16 (12–20) 17 (15–22) .054 Initial MRI Time from onset to initial MRI (min) 117 (87–144) 122 (96–159) .16 Available PWI sequence 68 (67%) 26 (67%) 1.00 Terminal ICA occlusion 39 (38%) 11 (28%) .27 Good-to-excellent FLAIR images 81 (79%) 24 (61%) .03 DWI1 volume (mL) 18 (8–35) 108 (57–160) <.001 PWI-DWI mismatch volume (mL)b 70 (40–105) 44 (33–64) .03 PWI-DWI mismatchb 56 (82%) 5 (19%) <.001 Cardioembolic stroke 61 (60%) 16 (41%) .05 24-Hour evolution Follow-up NIHSS score 11 (5–18) 16 (10–22) .004 DWI2 volume (mL)d 36 (19–66) 161 (95–230) <.001 Relative infarct progression (%)d 195 (112–356) 133 (114–165) .001 Complete recanalizationc,d 29 (29%) 12 (32%) .77 mRS score at 3 moe 3 (1–4) 4 (3–6) .001 mRS score ≤2 at 3 moe 45 (47%) 9 (24%) .02 Note:—BP indicates blood pressure.
↵a Numbers (not %) are mean ± SD or median (interquartile range).
↵b Ninety-four patients (PWI-DWI mismatch: >6-second Tmax, Volumehypoperfusion > 1.8 × VolumeDWI1).19
↵c TICI 3.
↵d 24-hour MRI available in 138 patients.
↵e mRS score at 3 months available in 133 patients.
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