Comparative analysis of core and perfusion lesion volumes between commercially available computed tomography perfusion software

Olli P Suomalainen; Nicolas Martinez-Majander; Gerli Sibolt; Katariina Bäcklund; Juha Järveläinen; Antti Korvenoja; Marjaana Tiainen; Nina Forss; Sami Curtze

doi:10.1177/23969873221135915

Comparative analysis of core and perfusion lesion volumes between commercially available computed tomography perfusion software

Eur Stroke J. 2023 Mar;8(1):259-267. doi: 10.1177/23969873221135915. Epub 2022 Nov 18.

Authors

Olli P Suomalainen¹, Nicolas Martinez-Majander¹, Gerli Sibolt¹, Katariina Bäcklund¹, Juha Järveläinen², Antti Korvenoja², Marjaana Tiainen¹, Nina Forss^{1

3}, Sami Curtze¹

Affiliations

¹ Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland.
² Department of Neuroradiology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland.
³ Department of Neuroscience and Biomedical Engineering, Aalto University, Finland.

Abstract

Introduction: Computed tomography perfusion (CTP) imaging has become an important tool in evaluating acute recanalization treatment candidates. Large clinical trials have successfully used RAPID automated imaging analysis software for quantifying ischemic core and penumbra, yet other commercially available software vendors are also on the market. We evaluated the possible difference in ischemic core and perfusion lesion volumes and the agreement rate of target mismatch between OLEA, MIStar, and Syngo.Via versus RAPID software in acute recanalization treatment candidates.

Patients and methods: All consecutive stroke-code patients with baseline CTP RAPID imaging at Helsinki University Hospital during 8/2018-9/2021 were included. Ischemic core was defined as cerebral blood flow <30% than the contralateral hemisphere and within the area of delay time (DT) >3s with MIStar. Perfusion lesion volume was defined as DT > 3 s (MIStar) and T_max > 6 s with all other software. A perfusion mismatch ratio of ⩾1.8, a perfusion lesion volume of ⩾15 mL, and ischemic core <70 mL was defined as target mismatch. The mean pairwise differences of the core and perfusion lesion volumes between software were calculated using the Bland-Altman method and the agreement of target mismatch between software using the Pearson correlation.

Results: A total of 1606 patients had RAPID perfusion maps, 1222 of which had MIStar, 596 patients had OLEA, and 349 patients had Syngo.Via perfusion maps available. Each software was compared with simultaneously analyzed RAPID software. MIStar showed the smallest core difference compared with RAPID (-2 mL, confidence interval (CI) from -26 to 22), followed by OLEA (2 mL, CI from -33 to 38). Perfusion lesion volume differed least with MIStar (4 mL, CI from -62 to 71) in comparison with RAPID, followed by Syngo.Via (6 mL, CI from -94 to 106). MIStar had the best agreement rate with target mismatch of RAPID followed by OLEA and Syngo.Via.

Discussion and conclusion: Comparison of RAPID with three other automated imaging analysis software showed variance in ischemic core and perfusion lesion volumes and in target mismatch.

Keywords: CT perfusion; Ischemic stroke; ischemic core; penumbra.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Diffusion Magnetic Resonance Imaging / methods
Humans
Perfusion
Software
Stroke* / pathology
Tomography, X-Ray Computed* / methods