title: Comparison of Perfusion CT Software to Predict the Final Infarct Volume After Thrombectomy.
abstract: OBJECTIVE
  Computed tomographic perfusion represents an interesting physiological imaging modality to select patients for reperfusion therapy in acute ischemic stroke. The purpose of our study was to determine the accuracy of different commercial perfusion CT software packages (Philips (A), Siemens (B), and RAPID (C)) to predict the final infarct volume (FIV) after mechanical thrombectomy.
  
  
  METHODS
  Single-institutional computed tomographic perfusion data from 147 mechanically recanalized acute ischemic stroke patients were postprocessed. Ischemic core and FIV were compared about thrombolysis in cerebral infarction (TICI) score and time interval to reperfusion. FIV was measured at follow-up imaging between days 1 and 8 after stroke.
  
  
  RESULTS
  In 118 successfully recanalized patients (TICI 2b/3), a moderately to strongly positive correlation was observed between ischemic core and FIV. The highest accuracy and best correlation are shown in early and fully recanalized patients (Pearson r for A=0.42, B=0.64, and C=0.83; P<0.001). Bland-Altman plots and boxplots demonstrate smaller ranges in package C than in A and B. Significant differences were found between the packages about over- and underestimation of the ischemic core. Package A, compared with B and C, estimated more than twice as many patients with a malignant stroke profile (P<0.001). Package C best predicted hypoperfusion volume in nonsuccessfully recanalized patients.
  
  
  CONCLUSIONS
  Our study demonstrates best accuracy and approximation between the results of a fully automated software (RAPID) and FIV, especially in early and fully recanalized patients. Furthermore, this software package overestimated the FIV to a significantly lower degree and estimated a malignant mismatch profile less often than other software.
authors: Departments of Radiology and Neuroradiology (F.A., C.R., T.K., T.L., M.H., F.W., O.J.) and Neurology (J.M., A.B.), University Hospital, Schleswig-Holstein, Campus Kiel, Germany. friederike.austein@uksh.de.
authors: Friederike
authors: F
authors: Austein
authors: Departments of Radiology and Neuroradiology (F.A., C.R., T.K., T.L., M.H., F.W., O.J.) and Neurology (J.M., A.B.), University Hospital, Schleswig-Holstein, Campus Kiel, Germany.
authors: Christian
authors: C
authors: Riedel
authors: Departments of Radiology and Neuroradiology (F.A., C.R., T.K., T.L., M.H., F.W., O.J.) and Neurology (J.M., A.B.), University Hospital, Schleswig-Holstein, Campus Kiel, Germany.
authors: Tina
authors: T
authors: Kerby
authors: Departments of Radiology and Neuroradiology (F.A., C.R., T.K., T.L., M.H., F.W., O.J.) and Neurology (J.M., A.B.), University Hospital, Schleswig-Holstein, Campus Kiel, Germany.
authors: Johannes
authors: J
authors: Meyne
authors: Departments of Radiology and Neuroradiology (F.A., C.R., T.K., T.L., M.H., F.W., O.J.) and Neurology (J.M., A.B.), University Hospital, Schleswig-Holstein, Campus Kiel, Germany.
authors: Andreas
authors: A
authors: Binder
authors: Departments of Radiology and Neuroradiology (F.A., C.R., T.K., T.L., M.H., F.W., O.J.) and Neurology (J.M., A.B.), University Hospital, Schleswig-Holstein, Campus Kiel, Germany.
authors: Thomas
authors: T
authors: Lindner
authors: Departments of Radiology and Neuroradiology (F.A., C.R., T.K., T.L., M.H., F.W., O.J.) and Neurology (J.M., A.B.), University Hospital, Schleswig-Holstein, Campus Kiel, Germany.
authors: Monika
authors: M
authors: Huhndorf
authors: Departments of Radiology and Neuroradiology (F.A., C.R., T.K., T.L., M.H., F.W., O.J.) and Neurology (J.M., A.B.), University Hospital, Schleswig-Holstein, Campus Kiel, Germany.
authors: Fritz
authors: F
authors: Wodarg
authors: Departments of Radiology and Neuroradiology (F.A., C.R., T.K., T.L., M.H., F.W., O.J.) and Neurology (J.M., A.B.), University Hospital, Schleswig-Holstein, Campus Kiel, Germany.
authors: Olav
authors: O
authors: Jansen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D012189:Retrospective Studies; D012984:Software; D020521:Stroke / Q000000981:diagnostic imaging*; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: perfusion imaging; reperfusion; software; stroke; thrombectomy