CT-NIHSS mismatch does not correlate with MRI diffusion-perfusion mismatch

Steven R. Messé, Scott E. Kasner, Julio A. Chalela, Brett Cucchiara, Andrew M. Demchuk, Michael D. Hill, Steven Warach

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE - MRI diffusion-perfusion mismatch may identify patients for thrombolysis beyond 3 hours. However, MRI has limited availability in many hospitals. We investigated whether mismatch between the Alberta Stroke Program Early CT Score (ASPECTS) and the NIH Stroke Scale (NIHSS) correlates with MRI diffusion-perfusion mismatch. METHODS - We retrospectively analyzed a cohort of consecutive acute ischemic stroke patients who underwent MRI and CT at admission. NIHSS was performed by the admitting physician. MRI and CT were reviewed by 2 blinded expert raters. Degree of MRI mismatch was defined as present (> 25%) or absent (<25%). Univariate and multivariate analyses were performed to determine characteristics associated with MRI mismatch. Probability of MRI mismatch was calculated for all combinations of ASPECTS and NIHSS cutoff scores. RESULTS - Included in the analysis were 143 patients. Median NIHSS on admission was 4 (IQR, 2 to 10); median ASPECTS was 10 (IQR, 9 to 10). Median time to completion of MRI and CT was 4.5 (2.5 to 13.9) hours after onset. CT and MRI were separated by a median of 35 (IQR, 29 to 44) minutes. MRI mismatch was present in 41% of patients. In multivariate analysis, only shorter time-to-scan (OR, 0.96 per hour; 95% CI, 0.92 to 1.0; P=0.043) was associated with MRI mismatch. There was no combination of NIHSS and ASPECTS thresholds that was significantly associated with MRI mismatch. CONCLUSIONS - ASPECTS-NIHSS mismatch did not correlate with MRI diffusion-perfusion mismatch in this clinical cohort. MRI mismatch was associated with decreasing time from stroke onset to scan.

Original languageEnglish (US)
Pages (from-to)2079-2084
Number of pages6
JournalStroke
Volume38
Issue number7
DOIs
StatePublished - Jul 2007

Fingerprint

Diffusion Magnetic Resonance Imaging
Perfusion
Stroke
Alberta
Multivariate Analysis

Keywords

  • Cerebral infarct
  • Computed tomography
  • Ischemic penumbra
  • Magnetic resonance imaging
  • Mismatch
  • Neuroradiology
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Messé, S. R., Kasner, S. E., Chalela, J. A., Cucchiara, B., Demchuk, A. M., Hill, M. D., & Warach, S. (2007). CT-NIHSS mismatch does not correlate with MRI diffusion-perfusion mismatch. Stroke, 38(7), 2079-2084. https://doi.org/10.1161/STROKEAHA.106.480731

CT-NIHSS mismatch does not correlate with MRI diffusion-perfusion mismatch. / Messé, Steven R.; Kasner, Scott E.; Chalela, Julio A.; Cucchiara, Brett; Demchuk, Andrew M.; Hill, Michael D.; Warach, Steven.

In: Stroke, Vol. 38, No. 7, 07.2007, p. 2079-2084.

Research output: Contribution to journalArticle

Messé, SR, Kasner, SE, Chalela, JA, Cucchiara, B, Demchuk, AM, Hill, MD & Warach, S 2007, 'CT-NIHSS mismatch does not correlate with MRI diffusion-perfusion mismatch', Stroke, vol. 38, no. 7, pp. 2079-2084. https://doi.org/10.1161/STROKEAHA.106.480731
Messé SR, Kasner SE, Chalela JA, Cucchiara B, Demchuk AM, Hill MD et al. CT-NIHSS mismatch does not correlate with MRI diffusion-perfusion mismatch. Stroke. 2007 Jul;38(7):2079-2084. https://doi.org/10.1161/STROKEAHA.106.480731
Messé, Steven R. ; Kasner, Scott E. ; Chalela, Julio A. ; Cucchiara, Brett ; Demchuk, Andrew M. ; Hill, Michael D. ; Warach, Steven. / CT-NIHSS mismatch does not correlate with MRI diffusion-perfusion mismatch. In: Stroke. 2007 ; Vol. 38, No. 7. pp. 2079-2084.
@article{35dc67cedee24edeb1dcb96a97148a8a,
title = "CT-NIHSS mismatch does not correlate with MRI diffusion-perfusion mismatch",
abstract = "BACKGROUND AND PURPOSE - MRI diffusion-perfusion mismatch may identify patients for thrombolysis beyond 3 hours. However, MRI has limited availability in many hospitals. We investigated whether mismatch between the Alberta Stroke Program Early CT Score (ASPECTS) and the NIH Stroke Scale (NIHSS) correlates with MRI diffusion-perfusion mismatch. METHODS - We retrospectively analyzed a cohort of consecutive acute ischemic stroke patients who underwent MRI and CT at admission. NIHSS was performed by the admitting physician. MRI and CT were reviewed by 2 blinded expert raters. Degree of MRI mismatch was defined as present (> 25{\%}) or absent (<25{\%}). Univariate and multivariate analyses were performed to determine characteristics associated with MRI mismatch. Probability of MRI mismatch was calculated for all combinations of ASPECTS and NIHSS cutoff scores. RESULTS - Included in the analysis were 143 patients. Median NIHSS on admission was 4 (IQR, 2 to 10); median ASPECTS was 10 (IQR, 9 to 10). Median time to completion of MRI and CT was 4.5 (2.5 to 13.9) hours after onset. CT and MRI were separated by a median of 35 (IQR, 29 to 44) minutes. MRI mismatch was present in 41{\%} of patients. In multivariate analysis, only shorter time-to-scan (OR, 0.96 per hour; 95{\%} CI, 0.92 to 1.0; P=0.043) was associated with MRI mismatch. There was no combination of NIHSS and ASPECTS thresholds that was significantly associated with MRI mismatch. CONCLUSIONS - ASPECTS-NIHSS mismatch did not correlate with MRI diffusion-perfusion mismatch in this clinical cohort. MRI mismatch was associated with decreasing time from stroke onset to scan.",
keywords = "Cerebral infarct, Computed tomography, Ischemic penumbra, Magnetic resonance imaging, Mismatch, Neuroradiology, Thrombolysis",
author = "Mess{\'e}, {Steven R.} and Kasner, {Scott E.} and Chalela, {Julio A.} and Brett Cucchiara and Demchuk, {Andrew M.} and Hill, {Michael D.} and Steven Warach",
year = "2007",
month = "7",
doi = "10.1161/STROKEAHA.106.480731",
language = "English (US)",
volume = "38",
pages = "2079--2084",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - CT-NIHSS mismatch does not correlate with MRI diffusion-perfusion mismatch

AU - Messé, Steven R.

AU - Kasner, Scott E.

AU - Chalela, Julio A.

AU - Cucchiara, Brett

AU - Demchuk, Andrew M.

AU - Hill, Michael D.

AU - Warach, Steven

PY - 2007/7

Y1 - 2007/7

N2 - BACKGROUND AND PURPOSE - MRI diffusion-perfusion mismatch may identify patients for thrombolysis beyond 3 hours. However, MRI has limited availability in many hospitals. We investigated whether mismatch between the Alberta Stroke Program Early CT Score (ASPECTS) and the NIH Stroke Scale (NIHSS) correlates with MRI diffusion-perfusion mismatch. METHODS - We retrospectively analyzed a cohort of consecutive acute ischemic stroke patients who underwent MRI and CT at admission. NIHSS was performed by the admitting physician. MRI and CT were reviewed by 2 blinded expert raters. Degree of MRI mismatch was defined as present (> 25%) or absent (<25%). Univariate and multivariate analyses were performed to determine characteristics associated with MRI mismatch. Probability of MRI mismatch was calculated for all combinations of ASPECTS and NIHSS cutoff scores. RESULTS - Included in the analysis were 143 patients. Median NIHSS on admission was 4 (IQR, 2 to 10); median ASPECTS was 10 (IQR, 9 to 10). Median time to completion of MRI and CT was 4.5 (2.5 to 13.9) hours after onset. CT and MRI were separated by a median of 35 (IQR, 29 to 44) minutes. MRI mismatch was present in 41% of patients. In multivariate analysis, only shorter time-to-scan (OR, 0.96 per hour; 95% CI, 0.92 to 1.0; P=0.043) was associated with MRI mismatch. There was no combination of NIHSS and ASPECTS thresholds that was significantly associated with MRI mismatch. CONCLUSIONS - ASPECTS-NIHSS mismatch did not correlate with MRI diffusion-perfusion mismatch in this clinical cohort. MRI mismatch was associated with decreasing time from stroke onset to scan.

AB - BACKGROUND AND PURPOSE - MRI diffusion-perfusion mismatch may identify patients for thrombolysis beyond 3 hours. However, MRI has limited availability in many hospitals. We investigated whether mismatch between the Alberta Stroke Program Early CT Score (ASPECTS) and the NIH Stroke Scale (NIHSS) correlates with MRI diffusion-perfusion mismatch. METHODS - We retrospectively analyzed a cohort of consecutive acute ischemic stroke patients who underwent MRI and CT at admission. NIHSS was performed by the admitting physician. MRI and CT were reviewed by 2 blinded expert raters. Degree of MRI mismatch was defined as present (> 25%) or absent (<25%). Univariate and multivariate analyses were performed to determine characteristics associated with MRI mismatch. Probability of MRI mismatch was calculated for all combinations of ASPECTS and NIHSS cutoff scores. RESULTS - Included in the analysis were 143 patients. Median NIHSS on admission was 4 (IQR, 2 to 10); median ASPECTS was 10 (IQR, 9 to 10). Median time to completion of MRI and CT was 4.5 (2.5 to 13.9) hours after onset. CT and MRI were separated by a median of 35 (IQR, 29 to 44) minutes. MRI mismatch was present in 41% of patients. In multivariate analysis, only shorter time-to-scan (OR, 0.96 per hour; 95% CI, 0.92 to 1.0; P=0.043) was associated with MRI mismatch. There was no combination of NIHSS and ASPECTS thresholds that was significantly associated with MRI mismatch. CONCLUSIONS - ASPECTS-NIHSS mismatch did not correlate with MRI diffusion-perfusion mismatch in this clinical cohort. MRI mismatch was associated with decreasing time from stroke onset to scan.

KW - Cerebral infarct

KW - Computed tomography

KW - Ischemic penumbra

KW - Magnetic resonance imaging

KW - Mismatch

KW - Neuroradiology

KW - Thrombolysis

UR - http://www.scopus.com/inward/record.url?scp=34347363130&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34347363130&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.106.480731

DO - 10.1161/STROKEAHA.106.480731

M3 - Article

VL - 38

SP - 2079

EP - 2084

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 7

ER -