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P28 Background and Aim: The presence of a  perfusion-weighted imaging (PWI) volume deficit greater than  diffusion-weighted imaging (DWI) volume predicts the presence of  salvageable tissue. The aim of this prospective study was to determine  the evolution of various parameters of perfusion within the ischemic  volume using serial MR imaging during the first 48 hours after stroke.Method: Five patients with middle cerebral artery (MCA) territory  ischemic stroke were imaged (echoplanar DWI, PWI, MR angiography)  within 6–10 hours of stroke onset, then at 15–18 hours, 22–24 hours  and 48 hours. No patient received thrombolytic or neuro-protective  agents.Results: Four of the 5 patients had a MCA occlusion  on the initial MR angiogram. Recanalization of the MCA was observed by  the second scan in one patient and by the fourth scan in the remaining  3 patients. Significant DWI and tissue mean transit time (tMTT) volume  mismatch (&gt;75%) was observed in 4 patients and moderate mismatch in 1  patient on the initial scan. A significant mismatch between DWI and  tMTT volume (&gt;70%) was observed in 2 patients by the second and third  scan. By the fourth scan no patient had a significant DWI and tMTT  volume mismatch. Significant mismatch (&gt;50%) between DWI and relative  blood volume/ relative blood flow (rCBV/rCBF) volume was observed in 3  of the 5 patients on the initial scan. Matched DWI and rCBV was  observed by the third scan in all patients. Matched DWI and rCBF was  observed by the second scan in all patients. A decrease in the size of  the tMTT volume prior to the recanalization of the MCA was likely due  to opening of collateral channels but the most dramatic decrease in the  size of tMTT volume occurred following recanalization of the MCA.Conclusion: The serial changes in tMTT, rCBV, rCBF progress  at different rates following acute ischemic stroke. These results have  implications for future studies basing thrombolytic therapy on DWI/PWI.  We caution that treatment based only on a tMTT/DWI mismatch may  overestimate the size of the salvageable tissue.

Differential evolution of tissue mean transit time, relative blood volume and flow deficits in acute ischemic stroke