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 journalArticlepeer-review

19 Scopus citations


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
Issue number7
StatePublished - Jul 2007


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

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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