Function of diffusion-weighted imaging-perfusion-weighted imaging mismatch for intravenous thrombolysis in patients with acute ischemic stroke

Abstract

Objective To assess the relationship between diffusion-weighted imaging-perfusion-weighted imaging (DWI-PWI) mismatch and the prognosis of patients with acute anterior circulation ischemic stroke receiving intravenous thrombolysis. Methods Patients with acute anterior circulation ischemic stroke who finished multimode MRI (T1WI, T2WI, DWI, PWI) within 4.5 hours after disease onset were recruited in this study. They were divided into DWI-PWI mismatched and matched groups. All patients received intravenous thrombolysis using recombinant tissue type plasminogen activator (rt-PA). Head CT was performed 24 hours later to exclude cerebral hemorrhage, and the patients were followed up for 3 months. The improvement of neurological function, the rate of death and symptomatic intracranial hemorrhage (sICH) were recorded. Results A total of 63 patients were recruited in this study, of which 41 patients presented DWI-PWI mismatch while 22 patients presented DWI-PWI match. Three months later, the rate of the improvement of neurological function in the DWI-PWI mismatched group was significantly higher than that in the DWI-PWI matched group (70.7% vs 40.9%, χ2=5.32, P=0.021). Of note, no significant difference in the rate of death and sICH was found between DWI-PWI mismatched and matched groups (9.8% vs 13.6%, χ2=0.22, P=0.640). Conclusions Compared with DWI-PWI matched group, the DWI-PWI mismatched group has better prognosis after receiving intravenous thrombolysis. The results provide more direct evidence supporting the application of intravenous thrombolysis under the guidance of multimode MRI in acute anterior circulation ischemic stroke. Key words: Brain ischemia; Stroke; Thrombolytic therapy; Magnetic resonance imaging; Time