Susceptibility-Diffusion Mismatch: An Effective Method By Which To Detect Perfusion-Diffusion Mismatch In Acute Ischemic Stroke

Asymmetrically hypointense veins (AHVs) on susceptibility-weighted imaging (SWI) have been proposed to be a surrogate marker by which to predict penumbra. This study aimed to assess the value of AHVs in detecting penumbra in acute ischemic stroke. We conducted a retrospective study of patients with acute anterior circulation ischemic stroke who underwent diffusion-weighted imaging (DWI), SWI, perfusion-weighted imaging (PWI), and magnetic resonance angiography (MRA). Stroke severities were measured using the National Institutes of Health Stroke Scale (NIHSS). A favorable outcome was defined as a modified Rankin Scale of 0-2 at 3.0 months. We evaluated AHVs, the infarction, and the perfusion lesions, and assessed the correlations of SWI/DWI with PWI/DWI and PWI-DWI mismatch volumes. The receiver operating characteristic (ROC) curve was used to find the cutoff SWI-DWI mismatch to detect optimal PWI-DWI mismatch. The associations of SWI-DWI mismatch with clinical data and MR parameters were analyzed. Fifty-three patients were enrolled in this study. SWI/DWI was positively correlated with PWI/DWI and PWI-DWI mismatch volumes. Patients with SWI-DWI mismatch were more likely to have stenosis of the internal cerebral artery or proximal middle cerebral artery, smaller infarction, and larger PWI-DWI mismatch volumes. The stroke severities of these patients on admission and at discharge were more likely to be mild or moderate. Favorable outcomes between the two groups were not significantly different. In conclusion, SWI-DWI mismatch is an effective method by which to evaluate the detection value of AHVs for penumbra, and is related to mild or moderate severity of acute stroke, but not to a favorable outcome.