To observe the cerebral microstructural alterations after focal ischemic stroke by using DKI and assess whether patients are likely to benefit from treated with intravenous tPA at onset of stroke when mean diffusion and kurtosis MRI mismatchs. 58 patients were enrolled. AK, RK and MK values were increased in ischemic lesions, which indicate heterogeneity and complexity of microstructural tissues at onset of stroke. MD-AK mismatch patients? recovered reasonably well with intravenous tPA at onset of stroke, whereas MD-AK mismatch patients without intravenous tPA and coincidence MD-AK of lesions volume showed poor recovery. MD-AK mismatch could be used to identify patients from baseline DKI who are likely to benefit from intravenous thrombolysis at onset of stroke.