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Site of the ischemic penumbra as a predictor of potential for recovery of functions

From the Department of Neurology (A.E.H., L.G., V.K., L.C., J.T.K., M.N., J.H.-G., C.D., E.A., R.L., R.F.G.) and Department of Physical Medicine and Rehabilitation (A.E.H., E.A.), Johns Hopkins University School of Medicine, and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD.

Address correspondence and reprint requests to Dr. Argye E. Hillis, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Meyer 6-113, 600 N. Wolfe St., Baltimore, MD 21287

Background and Purpose: Diffusion–perfusion mismatch has been used to estimate salvageable tissue and predict potential for recovery in acute stroke. Location of the salvageable tissue may be as important as volume or percentage in predicting potential for recovery of specific functions. Impaired naming, a common and disabling deficit after left hemisphere stroke, is often associated with tissue dysfunction of left Brodmann area (BA) 37, posterior inferior temporal cortex. We tested the hypothesis that the presence of diffusion–perfusion mismatch within left BA 37 predicts probability and extent of short-term improvement of naming.

Methods: One hundred five patients with acute left hemisphere ischemic stroke had diffusion-weighted imaging, perfusion-weighted imaging, a test of picture naming, and other language tests at admission and 2 to 4 days later. Linear regression was used to determine whether diffusion–perfusion mismatch in any BA in language cortex, total volume of mismatch, or diffusion or perfusion abnormality predicted degree of improvement in naming by days 3 to 5.

Results: The presence of >20% diffusion–perfusion mismatch in left BA 37 and total volumes of diffusion and perfusion abnormality at day 1 each independently predicted degree of improvement in naming. Mismatch in this area did not predict the degree of improvement in other language tests or the NIH Stroke Scale in this study.

Conclusions/Relevance: Diffusion–perfusion mismatch in left Brodmann area 37 was strongly associated with acute improvement in naming, independently of volume or percentage of total mismatch or diffusion or perfusion abnormality. These data indicate that mismatch in a particular area is a marker of salvageable tissue and an important predictor of potential for recovery of functions that depend on that area. Location of mismatch before treatment may help to predict potential benefits of reperfusion.

GLOSSARY: ADC = apparent diffusion coefficient; BA = Brodmann area; DWI = diffusion-weighted imaging; NIHSS = NIH Stroke Scale; PWI = perfusion-weighted imaging; TE = echo time; TR = repetition time; TTP = time to peak.

argye{at}jhmi.edu

Supported by NIH R01 DC05375 and P41 RR15241.

Disclosure: The authors report no disclosures.

Received July 26, 2007. Accepted in final form March 31, 2008.