Rapid Assessment of Perfusion–Diffusion Mismatch

Abstract

Background and Purpose— For MR perfusion–diffusion (PWI-DWI) mismatch to become routine in thrombolysis patient selection, rapid and reliable assessment tools are required. We examined interrater variability in PWI/DWI volume measurements and developed a rapid assessment tool based on the Alberta Stroke Program Early CT Scores (ASPECTS) system. Methods— DWI and PWI were performed in 35 patients with stroke Results— Interobserver variability was much greater for PWI (95% limit of agreement=±72.3 mL) than for DWI (95% limit of agreement=±12.6 mL). A semiautomated PWI volume (time to peak+2 s) was therefore used to calculate mismatch volume. MR mismatch scores ≥2 predicted 20% PWI-DWI mismatch by volume with mean 78% sensitivity (range, 72% to 84%) and 88% specificity (range, 83% to 90%). There was excellent agreement on mismatch classification using MR mismatch scores between experienced raters (weighted kappa scores of 0.94) with agreement in 34 of 35 cases. Agreement was less consistent between inexperienced raters (weighted kappa=0.49, 28 of 35 cases). Conclusions— Variability in planimetric mismatch measurements arises primarily from differences in PWI volume assessment. High specificity and interrater reliability may make MR mismatch scores an ideal rapid screening tool for potential thrombolysis patients.