Agreement of three CT perfusion software packages in patients with acute ischemic stroke: A comparison with RAPID

Qingqing Lu; Junyan Fu; Kun Lv; Yan Han; Yuning Pan; Yiren Xu; Jun Zhang; Daoying Geng

doi:10.1016/j.ejrad.2022.110500

Agreement of three CT perfusion software packages in patients with acute ischemic stroke: A comparison with RAPID

Eur J Radiol. 2022 Nov:156:110500. doi: 10.1016/j.ejrad.2022.110500. Epub 2022 Aug 27.

Authors

Qingqing Lu¹, Junyan Fu², Kun Lv², Yan Han², Yuning Pan³, Yiren Xu³, Jun Zhang⁴, Daoying Geng⁵

Affiliations

¹ Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China; Department of Radiology, Ningbo First Hospital, Ningbo 315000, China.
² Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China.
³ Department of Radiology, Ningbo First Hospital, Ningbo 315000, China.
⁴ Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai 200040, China. Electronic address: zhangjun_zj@fudan.edu.cn.
⁵ Department of Radiology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200040, China; Center for Shanghai Intelligent Imaging for Critical Brain Diseases Engineering and Technology Reasearch, Huashan Hospital, Fudan Universtiy, Shanghai 200040, China. Electronic address: gdy_2019@163.com.

PMID: 36099834
DOI: 10.1016/j.ejrad.2022.110500

Abstract

Purpose: To compare ischemic core volume (ICV) and penumbra volume (PV) measured by MIStar, F-STROKE, and Syngo.via with that measured by RAPID in acute ischemic stroke (AIS), and their concordance in selecting patients for endovascular thrombectomy (EVT).

Methods: Computed tomography perfusion (CTP) data were processed with four software packages. Bland-Altman analysis and intraclass correlation coefficient (ICC) were performed to evaluate their agreement in quantifying ICV and PV. Kappa test was conducted to assess consistency in the selection of EVT candidates. The correlation between predicted ICV and segmented final infarct volume (FIV) on follow-up images was investigated.

Results: A total of 91 patients were retrospectively included. F-STROKE had the best consistency with RAPID (ICV: ICC = 0.97; PV: ICC = 0.84) and Syngo.via had the worst consistency (ICV: ICC = 0.77; PV: ICC = 0.66). F-STROKE had the narrowest limits of agreements both in ICV (-27.02, 24.40 mL) and PV (-85.59, 101.80 mL). When selecting EVT candidates, MIStar (kappa = 0.71-0.88) and F-STROKE (kappa = 0.84-0.90) had good to excellent consistency with RAPID, while Syngo.via had poor consistency (kappa = 0.20-0.41). ICV predicted by MIStar was correlated strongest with FIV (r = 0.77).

Conclusions: F-STROKE is most consistent with RAPID in quantitative ICV and PV. F-STROKE and MIStar exhibit similar EVT candidate selection to RAPID. Syngo.via, for its part, seems to have overestimated ICV and underestimated PV, leading to an overly restrictive selection of EVT candidates.

Keywords: Acute ischemic stroke; CT perfusion; Endovascular thrombectomy; Ischemic core; Penumbra; Processing software.