Translational Stroke Research

, Volume 3, Issue 2, pp 188–197

Perfusion/Diffusion Mismatch Is Valid and Should Be Used for Selecting Delayed Interventions

  • Stephen Davis
  • Bruce Campbell
  • Soren Christensen
  • Henry Ma
  • Patricia Desmond
  • Mark Parsons
  • Christopher Levi
  • Christopher Bladin
  • P. Alan Barber
  • Geoffrey Donnan
Review Article


The mismatch between a larger perfusion lesion and smaller diffusion lesion on magnetic resonance imaging is a validated signal of the ischemic penumbra, namely the region at risk in acute ischemic stroke that is critically hypoperfused and the target of reperfusion therapies. Clinical trials have shown strong correlations between reperfusion in mismatch patients and improved clinical outcomes. Attenuation of infarct growth is associated with reperfusion and corresponding clinical gains. Using computed tomography perfusion, the mismatch between relative cerebral blood flow or cerebral blood volume and perfusion delay is a comparable penumbral marker. Automated techniques allow rapid quantitative assessment of mismatch with thresholding to exclude benign oligemia. The penumbra is often present beyond the current 4.5-h time window, defined for the use of intravenous tPA. Treatment beyond this time point remains investigational. Although the efficacy of thrombolysis in mismatch patients requires further validation in randomized trials, there is now sufficient evidence to recommend that advanced neuroimaging of mismatch should be used for selection of delayed therapies in phase 3 trials.


MRI Mismatch Ischemic penumbra Stroke Therapy 


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Stephen Davis
    • 1
    • 2
  • Bruce Campbell
    • 1
    • 2
  • Soren Christensen
    • 1
    • 2
  • Henry Ma
    • 3
  • Patricia Desmond
    • 1
    • 2
  • Mark Parsons
    • 5
  • Christopher Levi
    • 5
  • Christopher Bladin
    • 4
  • P. Alan Barber
    • 6
  • Geoffrey Donnan
    • 3
  1. 1.Department of Medicine, Melbourne Brain Centre at the Royal Melbourne HospitalUniversity of MelbourneMelbourneAustralia
  2. 2.Departments of Medicine and Radiology, Royal Melbourne HospitalUniversity of MelbourneMelbourneAustralia
  3. 3.Florey Neuroscience Institutes and University of MelbourneCarlton SouthAustralia
  4. 4.Department of Neurosciences, Box Hill Hospital, Eastern HealthMonash UniversityMelbourneAustralia
  5. 5.Priority Research Centre for Translational Neuroscience and Mental HealthUniversity of Newcastle and Hunter Medical Research InstituteNewcastleAustralia
  6. 6.Centre for Brain ResearchUniversity of AucklandAucklandNew Zealand

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