Diffusion-perfusion mismatch in single subcortical infarction: A predictor of early neurological deterioration and poor functional outcome

Abstract

© 2015 S. Karger AG, Basel.Background/Aims: Early neurological deterioration (END) is frequently observed and related to poor functional outcome in patients with single subcortical infarction (SSI). We evaluated the role of diffusion-perfusion mismatch (DPM) as a predictor of END and functional outcome in patients with SSI. Methods: We retrospectively analyzed data for 274 patients with acute SSI. DPM was positive in the presence of a lesion on the perfusion map that was larger than that on the corresponding slice on diffusion-weighted imaging. END was defined as an increase of <1 points in the motor portion of the National Institute of Health Stroke Scale (NIHSS) within 72 h from MRI acquisition. Patients with a modified Rankin Scale (mRS) score of 3 or more at day 30 were considered having a poor functional outcome. Results: DPM was more frequently observed in the END (+) than in the END (-) group (21/35 (60.0%) vs. 50/239 (20.9%); p < 0.001). After adjusting for covariates, the presence of DPM and NIHSS score on admission were independently associated with END (DPM, OR 5.03, p < 0.001; NIHSS, OR 1.14, p = 0.033) and poor functional outcome (DPM, OR 2.44, p = 0.018; NIHSS, OR 1.48, p < 0.001). Conclusions: The DPM concept is applicable to prediction of END and functional disability in patients with SSI.