Translational perspectives on perfusion–diffusion mismatch in ischemic stroke


  • Bruce C. V. Campbell,

    1. Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
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  • I. Mhairi Macrae

    Corresponding author
    1. Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
    • Correspondence: I. Mhairi Macrae, Institute of Neuroscience and Psychology, Wellcome Surgical Institute, University of Glasgow, Garscube Estate, Glasgow G61 1QH, UK.


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  • Conflicts of interest: B. C. V. Campbell received speaker's honoraria from Boehringer Ingelheim and acted as a consultant for Lundbeck. I. M. Macrae has nothing to declare.


Magnetic resonance imaging has tremendous potential to illuminate ischemic stroke pathophysiology and guide rational treatment decisions. Clinical applications to date have been largely limited to trials. However, recent analyses of the major clinical studies have led to refinements in selection criteria and improved understanding of the potential implications for the risk vs. benefit of thrombolytic therapy. In parallel, preclinical studies have provided complementary information on the evolution of stroke that is difficult to obtain in humans due to the requirement for continuous or repeated imaging and pathological verification. We review the clinical and preclinical advances that have led to perfusion–diffusion mismatch being applied in phase 3 randomized trials and, potentially, future routine clinical practice.