CT Hypoperfusion-Hypodensity Mismatch to Identify Patients With Acute Ischemic Stroke Within 4.5 Hours of Symptom Onset

Peter B. Sporns, André Kemmling, Heike Minnerup, Lennart Meyer, Christos Krogias, Volker Puetz, Kolja Thierfelder, Marco Duering, Daniel Kaiser, Soenke Langner, Christina Massoth, Alex Brehm, Lukas Rotkopf, Wolfgang G. Kunz, André Karch, Jens Fiehler, Walter Heindel, Peter Schramm, Georg Royl, Heinz WiendlMarios Psychogios, Jens Minnerup*

*Corresponding author for this work
5 Citations (Scopus)


Background and Objectives To test the hypothesis that CT hypoperfusion-hypodensity mismatch identifies patients with ischemic stroke within 4.5 hours of symptom onset. Methods We therefore performed the Retrospective Multicenter Hypoperfusion-Hypodensity Mismatch for The identification of Patients With Stroke Within 4.5 Hours study of patients with acute ischemic stroke and known time of symptom onset. The predictive values of hypoperfusion-hypodensity mismatch for the identification of patients with symptom onset within 4.5 hours were the main outcome measure. Results Of 666 patients, 548 (82.3%) had multimodal CT within 4.5 hours and 118 (17.7%) beyond 4.5 hours. Hypoperfusion-hypodensity mismatch was visible in 516 (94.2%) patients with symptom onset within and in 30 (25.4%) patients beyond 4.5 hours. CT hypoperfusion-hypodensity mismatch identified patients within 4.5 hours of stroke onset with 94.2% (95% confidence interval [CI] 91.9%–95.8%) sensitivity, 74.6% (95% CI 66.0%–81.6%) specificity, 94.5% (95% CI 92.3%–96.1%) positive predictive value, and 73.3% (95% CI 64.8%–80.4%) negative predictive value. Interobserver agreement for hypoperfusion-hypodensity mismatch was substantial (κ = 0.61, 95% CI 0.53–0.69). Discussion Patients with acute ischemic stroke with absence of a hypodensity on native CT (NCCT) within the hypoperfused core lesion on perfusion CT (hypoperfusion-hypodensity mismatch) are likely to be within the time window of thrombolysis. Applying this method may guide the decision to use thrombolysis in patients with unknown time of stroke onset.

Original languageEnglish
Issue number21
Pages (from-to)E2088-E2095
Publication statusPublished - 23.11.2021

Research Areas and Centers

  • Academic Focus: Center for Brain, Behavior and Metabolism (CBBM)

DFG Research Classification Scheme

  • 206-07 Clinical Neurology Neurosurgery and Neuroradiology

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