Comparison of Two Software Packages for Perfusion Imaging: Ischemic Core and Penumbra Estimation and Patient Triage in Acute Ischemic Stroke

Xiang Zhou; Yashi Nan; Jieyang Ju; Jingyu Zhou; Huanhui Xiao; Silun Wang

doi:10.3390/cells11162547

Comparison of Two Software Packages for Perfusion Imaging: Ischemic Core and Penumbra Estimation and Patient Triage in Acute Ischemic Stroke

Cells. 2022 Aug 16;11(16):2547. doi: 10.3390/cells11162547.

Authors

Xiang Zhou¹, Yashi Nan², Jieyang Ju³, Jingyu Zhou², Huanhui Xiao², Silun Wang²

Affiliations

¹ Department of Radiology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Rd., Shanghai 200065, China.
² YIWEI Medical Technology Co., Ltd., Room 1001, MAI KE LONG Building, Shenzhen 518000, China.
³ The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Rd., Nanjing 210011, China.

Abstract

Purpose: Automated postprocessing packages have been developed for managing acute ischemic stroke (AIS). These packages identify ischemic core and penumbra using either computed tomographic perfusion imaging (CTP) data or magnetic resonance imaging (MRI) data. Measurements of abnormal tissues and treatment decisions derived from different vendors can vary. The purpose of this study is to investigate the agreement of volumetric and decision-making outcomes derived from two software packages. Methods: A total of 594 AIS patients (174 underwent CTP and 420 underwent MRI) were included. Imaging data were accordingly postprocessed by two software packages: RAPID and RealNow. Volumetric outputs were compared between packages by performing intraclass correlation coefficient (ICC), Wilcoxon paired test and Bland-Altman analysis. Concordance of selecting patients eligible for mechanical thrombectomy (MT) was assessed based on neuroimaging criteria proposed in DEFUSE3. Results: In the group with CTP data, mean ischemic core volume (ICV)/penumbral volume (PV) was 14.9/81.1 mL via RAPID and 12.6/83.2 mL via RealNow. Meanwhile, in the MRI group, mean ICV/PV were 52.4/68.4 mL and 48.9/61.6 mL via RAPID and RealNow, respectively. Reliability, which was measured by ICC of ICV and PV in CTP and MRI groups, ranged from 0.87 to 0.99. The bias remained small between measurements (CTP ICV: 0.89 mL, CTP PV: -2 mL, MRI ICV: 3.5 mL and MRI PV: 6.8 mL). In comparison with CTP ICV with follow-up DWI, the ICC was 0.92 and 0.94 for RAPID and Realnow, respectively. The bias remained small between CTP ICV and follow-up DWI measurements (Rapid: -4.65 mL, RealNow: -3.65 mL). Wilcoxon paired test showed no significant difference between measurements. The results of patient triage were concordant in 159/174 cases (91%, ICC: 0.90) for CTP and 400/420 cases (95%, ICC: 0.93) for MRI. Conclusion: The CTP ICV derived from RealNow was more accurate than RAPID. The similarity in volumetric measurement between packages did not necessarily relate to equivalent patient triage. In this study, RealNow showed excellent agreement with RAPID in measuring ICV and PV as well as patient triage.

Keywords: RAPID; RealNow; acute ischemic stroke; ischemic core; penumbra.

Publication types

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

MeSH terms

Brain Ischemia* / diagnostic imaging
Brain Ischemia* / therapy
Cytidine Triphosphate
Humans
Ischemic Stroke* / diagnostic imaging
Perfusion
Perfusion Imaging / methods
Reproducibility of Results
Software
Stroke* / pathology
Triage

Substances

Cytidine Triphosphate

Grants and funding

This study was partially supported by the Science and Technology Commission of Shanghai Municipality (grant No. 19411951400); the Clinical Research Plan of SHDC (grant No. SHDC2020CR1038B); National Natural Science Foundation of China (Grant Nos. 81830059, 82102023).