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Could clinical diffusion-mismatch determined using DWI ASPECTS predict neurological improvement after thrombolysis before 3 h after acute stroke?
  1. Yuka Terasawa1,2,
  2. Kazumi Kimura1,
  3. Yasuyuki Iguchi1,
  4. Kazuto Kobayashi1,
  5. Junya Aoki1,
  6. Kensaku Shibazaki1,
  7. Ryuji Kaji2
  1. 1Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan
  2. 2Department of Clinical Neuroscience, Graduate School of Medicine, University of Tokushima, Tokushima, Japan
  1. Correspondence to Dr Yuka Terasawa, Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, Okayama 701-0192, Japan; tera{at}


Background Clinical-diffusion mismatch (CDM) between stroke severity and volume of diffusion-weighted imaging (DWI) lesions seems to predict penumbra. The Alberta Stroke Program Early CT Score on DWI (DWI ASPECTS) is a simple score for identifying ischaemic lesions. The authors examined whether CDM using DWI ASPECTS can predict neurological improvement in patients with acute stroke treated with intravenous tissue plasminogen activator (t-PA).

Methods The authors enrolled consecutive patients with anterior circulation stroke treated with intravenous t-PA. The authors calculated a cut-off value for CDM using DWI ASPECTS. After excluding a group of patients with mild symptoms (National Institutes of Health Stroke Scale (NIHSS) score <8), the authors divided the patients into two groups by presence or not of CDM (a positive group (P-CDM) and a negative group (N-CDM)). The authors then compared clinical characteristics including NIHSS score and modified Rankin Scale at 90 days after intravenous t-PA.

Results Seventy-one patients (male 41, mean age 74 years) were enrolled. DWI ASPECTS was linearly related to DWI lesion volume. The authors defined CDM as NIHSS scores ≥8 and DWI ASPECTS ≥7. The P-CDM group had 35 patients (61%) and the N-CDM group 22 patients (39%). NIHSS scores on admission were 15 (median) in P-CDM and 20 in N-CDM (p=0.004). NIHSS scores after intravenous t-PA improved in P-CDM but were unchanged in N-CDM (7 vs 20 at 7 days, p=0.033 on ANOVA). A favourable outcome at 90 days, defined as modified Rankin scale 0–3, was found in 46% of P-CDM patients and 14% of N-CDM patients (p=0.020).

Conclusion CDM determined using DWI ASPECTS may be associated with neurological improvement in patients treated with intravenous t-PA.

  • DWI
  • rt-PA
  • cerebrovascular disease
  • MRI

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  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Ethics Committee of Kawasaki Medical School.

  • Provenance and peer review Not commissioned; externally peer reviewed.