This study aimed to quantitatively assess the consistency and correlation between perfusion weighted imaging (PWI)/ diffusion weighted imaging (DWI) Alberta Stroke Program Early CT Score (ASPECTS) mismatch and PWI/DWI mismatch. Sixty-eight acute ischemic stroke with middle cerebral artery occlusion who underwent magnetic resonance imaging before thrombectomy were eligible. DWI volume, PWI volume and PWI-DWI mismatch were measured. DWI-, PWI-, PWI-DWI ASPECTS were evaluated. Statistical analysis was performed to compare the correlation between volume and ASPECTS of DWI-, PWI- and PWI-DWI mismatch. Receiver operating characteristic curve analysis was used to assess the predictive value of the PWI-DWI ASPECTS mismatch for the occurrence of PWI-DWI mismatch in acute ischemic stroke patients with middle cerebral artery occlusion. Of 68 patients, the DWI volume, PWI volume and PWI-DWI mismatch volume were (27.76 ± 17.53) mL, (167.09 ± 59.64) mL and (139.33 ± 58.18) mL respectively. DWI-ASPECTS was 6.75 ± 1.90 with the interobserver agreement was κ=0.98 (95% CI, 0.95–0.99); PWI-ASPECTS was 3.09 ± 2.11 with the interobserver agreement was κ=0.95 (95% CI, 0.91–0.99); PWI-DWI ASPECTS mismatch was 6.75 ± 1.90. Spearman's rank correlation analysis revealed that PWI-DWI mismatch volume was negatively correlated with PWI-DWI ASPECTS mismatch (r = −0.802; P = .000). Receiver operating characteristic analysis showed that when the PWI-DWI ASPECTS mismatch cut point was ≥ 2, the under curve of PWI-DWI ASPECTS mismatch for predicting PWI-DWI mismatch was 0.954 (95%CI, 0.911–0.998), with the sensitivity and specificity were 84.00% and 100% respectively. PWI-DWI ASPECTS mismatch may represent a convenient surrogate for penumbra in clinical trials.

PurposeLeukoaraiosis (LA) is a major public issue that affects elderly adults. However, the underlying neuropathological mechanism of LA without cognitive impairment requires examination. The present study aimed to explore the dynamic functional network connectivity (dFNC) in LA patients without cognitive impairment.MethodsTwenty-three patients with LA and 20 well-matched healthy controls were recruited for the present study. Each subject underwent magnetic resonance imaging (MRI) scanning and cognition evaluations. Spatial independent component analysis was conducted to evaluate dynamic functional connectivity. The differences in dFNC were determined and correlated with cognitive performance.ResultsCompared with controls, LA without cognitive impairment showed aberrant dFNC in State 1, involving increased connectivity in the default mode network (DMN) with the executive control network (ECN). In addition, decreased connectivity in the DMN with the salience network (SN) was found in State 3. Furthermore, the decreased number of transitions between states was positively associated with the visuospatial/executive score (Spearman's rho = 0.452, p = 0.031), and the longer mean dwell time in State 1 was negatively associated with the Montreal Cognitive Assessment (MoCA) score (Spearman's rho = – 0.420, p = 0.046).ConclusionThese findings enrich our understanding of the neural mechanisms underlying LA and may serve as a potential imaging biomarker for investigating and recognizing the LA at an early stage.