DWI-FLAIR Mismatch to Identify Acute Ischemic Stroke: Promising Data

A multicenter study suggests that the presence of mismatch between diffusion-weighted and fluid-attenuated inversion-recovery images may be a useful surrogate marker for ischemic stroke presentation within the time window for treatment with intravenous thrombolysis.

Approximately 25% of patients with acute ischemic stroke are ineligible for intravenous tissue plasminogen activator (IV t-PA) because the time of onset is unknown (e.g., because symptoms were noticed upon awakening from sleep). A surrogate marker confirming time from onset <4.5 hours would be valuable, potentially allowing substantially more patients to be treated. To ensure safety, a surrogate marker must have high specificity as well as a high positive predictive value. Several small single-center studies have suggested that lesion identification on diffusion-weighted imaging (DWI) but not on fluid-attenuated inversion-recovery imaging (FLAIR; DWI-FLAIR mismatch) might serve as such a marker.

In a multicenter, observational study, researc…

Reviewing Author

Chelsea S. Kidwell, MD

DWI-FLAIR Mismatch to Identify Acute Ischemic Stroke: Promising Data

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Reviewing Author