Neuroimaging: perfusion mismatch in stroke: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Radiology · Neuroimaging: perfusion mismatch in stroke

Sample item

A patient with a large vessel occlusion presents 9 hours after symptom onset. Perfusion imaging shows a small infarct core and a much larger region of hypoperfused but viable tissue. How is this interpreted?

AA venous infarct requiring anticoagulation onlyBA completed infarct, so reperfusion is futileCVasogenic oedema needing steroidsDA salvageable penumbra, supporting mechanical thrombectomy

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. A salvageable penumbra, supporting mechanical thrombectomy

A mismatch between a small core on diffusion or CBV and a larger hypoperfused area on perfusion imaging defines the penumbra at risk. Selected patients may benefit from thrombectomy in an extended window. A large core with little mismatch shows little tissue to save.

Option by option

A. A venous infarct requiring anticoagulation only
Nothing in the stem suggests a venous cause.
B. A completed infarct, so reperfusion is futile
A small core with a large mismatch is the opposite of a completed infarct.
C. Vasogenic oedema needing steroids
Steroids do not treat ischaemic penumbra.
D. A salvageable penumbra, supporting mechanical thrombectomy (correct)
Correct. Mismatch indicates salvageable tissue.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, A salvageable penumbra, supporting mechanical thrombectomy. A mismatch between a small core on diffusion or CBV and a larger hypoperfused area on perfusion imaging defines the penumbra at risk.

Why is "A venous infarct requiring anticoagulation only" not the answer?

Nothing in the stem suggests a venous cause.

Why is "A completed infarct, so reperfusion is futile" not the answer?

A small core with a large mismatch is the opposite of a completed infarct.

Why is "Vasogenic oedema needing steroids" not the answer?

Steroids do not treat ischaemic penumbra.

What concept does this question test?

It tests Neuroimaging: perfusion mismatch in stroke in Radiology. Selected patients may benefit from thrombectomy in an extended window. A large core with little mismatch shows little tissue to save.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: perfusion mismatch in stroke?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.