Visual assessment of perfusion-diffusion mismatch is inadequate to select patients for thrombolysis for the epithet investigators

Abstract

Background: For MR perfusion-diffusion mismatch to be clinically useful as a means of selecting patients for thrombolysis, it needs to occur in real time at the MRI console. Visual mismatch assessment has been used clinically and in trials but has not been systematically validated. We compared the accuracy of visually rating console-generated images with offline volumetric measurements using data from the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). Methods: Perfusion time-to-peak (TTP) and diffusion-weighted images (DWI) (as generated by commercial MRI console software) and Tmax perfusion maps (which required offline calculation) were visually rated. Perfusion-diffusion misma..