1. Identification of the Mismatch: Towards Certification

2. The Need No one method of perfusion calculation or even mismatch calculation has emerged. Continued algorithmic improvements and scanner technology advances suggest further improvements ahead Nevertheless, trials need to proceed

3. A potential solution Create a database of cases including: – Clear Mismatch, would aggressively intervene – No Mismatch, would not aggressively intervene – ? Perhaps some cases that are vague Convene an Expert panel to reach judgment on each case Convene a second Expert panel to assess degree of agreement (e.g., 90%) Make database available to others for testing and possible certification