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Title: Fragmentation of the classical magnetic resonance mismatch "penumbral" pattern with time.
Austin Authors: Ma, Henry K;Zavala, Jorge A;Teoh, Hock;Churilov, Leonid ;Gunawan, Marveyles;Ly, John;Wright, Peter;Phan, Thanh;Arakawa, Shuji;Davis, Stephen M;Donnan, Geoffrey A 
Affiliation: National Stroke Research Institute, Austin Health, University of Melbourne, 300 Waterdale Rd, Heidelberg West, Vic 3081, Australia
Issue Date: 22-Oct-2009
Publication information: Stroke; A Journal of Cerebral Circulation 2009; 40(12): 3752-7
Abstract: 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.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.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.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.
Gov't Doc #: 19850896
DOI: 10.1161/STROKEAHA.109.555011
Type: Journal Article
Subjects: Aged
Aged, 80 and over
Brain.blood supply.pathology.physiopathology
Brain Infarction.diagnosis.physiopathology
Brain Ischemia.diagnosis.physiopathology
Cohort Studies
Diffusion Magnetic Resonance Imaging.methods
Disease Progression
Image Processing, Computer-Assisted
Infarction, Middle Cerebral Artery.diagnosis.physiopathology
Middle Aged
Middle Cerebral Artery.pathology.physiopathology
Perfusion Imaging.methods
Predictive Value of Tests
Sensitivity and Specificity
Time Factors
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