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9 The degree of expansion of the early DWI lesion into the  volume of the baseline PWI lesion is variable. In some patients partial  recruitment of the DWI lesion volume occurs, while other patients  develop a DWI lesion that equals or exceeds the size of the initial PWI  volume. We investigated whether a quantitative analysis of the severity  of the early perfusion deficit predicted the evolution of the PWI/DWI  mismatch. Methods We studied patients with acute ischemic stroke in  whom PWI and DWI MRI were performed within 7 hours after symptom onset  and after 4–5 days. Maps of CBF, CBV and Mean Transit Time(MTT)were  created after deconvolution of the arterial input function with the  time-concentration curve. We compared the lesion volume on DWI at f/u  with the baseline MTT volume. Patients in whom the lesion volume on DWI  at f/u was smaller than the initial PWI deficit (group 1) were compared  with patients in whom the DWI lesion at f/u (group 2) was ≥ than  the initial PWI volume. Characteristics analysed included age, NIHSS,  time to MRI, initial DWI volume, initial PWI volume, absolute mismatch  volume, relative MTT(rMTT), CBF(rCBF) and CBV (rCBV) of the baseline  PWI. Results Thirteen patients had an initial PWI&gt;DWI mismatch of  &gt;20%. Seven of these patients (group 1) had DWI lesions at f/u that  were smaller than the initial PWI lesion (mean 55% of PWI volume),  while in 4 patients (group 2) the f/u DWI volume was larger than the  PWI volume (mean 121% of initial PWI volume). Only the median rMTT  (2.7 [group 1] versus 5.2 [group 2], p=0.006) and the median rCBV  (1.4 [group 1] versus 2.7 [group 2], p=0.006) differed between the  two groups. The initial rMTT and rCBV correlated significantly with the  degree of expansion of the DWI lesion (ρ= 0.918 for rMTT and 0.864  for rCBV, p DWI, who do not have early reperfusion, the  degree of expansion of the initial DWI lesion correlates with the  severity of the initial perfusion deficit as measured by the rMTT and  the rCBV.

Does the Severity of the Early Perfusion Deficit in Ischemic Stroke Predict the Fate of The PWI/DWI Mismatch?