Hyperacute-phase computed tomography-diffusion-weighted imaging discrepancy and response to thrombolysis.

This study investigated the incidence and clinical features of reversed discrepancy (RD) in patients with hyperacute ischemic stroke. Sixty-two patients with anterior circulation ischemic stroke were enrolled. All patients underwent computed tomography (CT) and magnetic resonance imaging within 3 hours and received therapy with intravenous tissue plasminogen activator. The relationships between the Alberta Stroke Programme Early CT Score on CT and diffusion-weighted imaging (DWI); deep white matter lesion on DWI (DWI-W), CT, or magnetic resonance imaging after 24 hours; dramatic improvement (defined as a change in National Institutes of Health Stroke Scale score of ≥ 10 points or a total National Institutes of Health Stroke Scale score of 0 or 1 after 24 hours); and thrombolysis-related hemorrhage were assessed. Two investigators identified RD when the early ischemic change was detected on CT but no obvious hyperintensity was noted on DWI. RD was found in 10 patients (16.1%), located in the basal ganglia in 5 patients (50%), in the basal ganglia plus the cortical area in 3 patients (30%), and in the cortical area in 2 patients (20%). Four of these 10 patients had an infarction of the basal ganglia and a DWI-W lesion. All 4 patients with both RD in the basal ganglia (bRD) and DWI-W (the bRD+W+ group) had an infarction of the basal ganglia within 24 hours. In contrast, all 4 patients with bRD but without DWI-W (the bRD+W- group) had no basal ganglia infarction. Dramatic improvement after intravenous tissue plasminogen activator therapy was significantly less common in the bRD+W+ group (0 of 4 patients) than in the bRD+W- group (3 of 4 patients; P = .0285). Our findings suggest that the presence of both bRD and a DWI-W lesion can be used to predict whether dramatic improvement will occur and whether the basal ganglia will progress to infarction.