Diffusion-Weighted Image (DWI) and Fluid-Attenuated Inversion Recovery Image (FLAIR) Mismatch on MRI can be used as a surrogate for the time of stroke onset for unclear-onset strokes or "wake up" (nocturnal) strokes.
DWI - takes 15 minutes to become positive in an acute stroke
FLAIR - takes 5 hours to become positive in an acute stroke
Acute ischemic lesions that are visible on DWI, but not on FLAIR images, that is, patients with DWI–FLAIR mismatch, are likely to be within the therapeutic time window (3 or 4.5 hours from stroke onset) for thrombolysis.
PS: DWI–FLAIR mismatch decreases as time passes after stroke onset, and the time from stroke onset to MRI correlates with the FLAIR signal intensity.
-IkaN
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