Diffusion-Perfusion Mismatch in Single Subcortical Infarction: A Predictor of Early Neurological Deterioration and Poor Functional Outcome

Early neurological deterioration (END) is frequently observed and related to poor functional outcome in patients with single subcortical infarction (SSI). We evaluated the role of diffusion-perfusion mismatch (DPM) as a predictor of END and functional outcome in patients with SSI.We retrospectively analyzed data for 274 patients with acute SSI. DPM was positive in the presence of a lesion on the perfusion map that was larger than that on the corresponding slice on diffusion-weighted imaging. END was defined as an increase of <1 points in the motor portion of the National Institute of Health Stroke Scale (NIHSS) within 72 h from MRI acquisition. Patients with a modified Rankin Scale (mRS) score of 3 or more at day 30 were considered having a poor functional outcome.DPM was more frequently observed in the END (+) than in the END (-) group (21/35 (60.0%) vs. 50/239 (20.9%); p < 0.001). After adjusting for covariates, the presence of DPM and NIHSS score on admission were independently associated with END (DPM, OR 5.03, p < 0.001; NIHSS, OR 1.14, p = 0.033) and poor functional outcome (DPM, OR 2.44, p = 0.018; NIHSS, OR 1.48, p < 0.001).The DPM concept is applicable to prediction of END and functional disability in patients with SSI.