Enhancing performance of a computed tomography perfusion software for improved prediction of final infarct volume in acute ischemic stroke patients

Author:

Rava Ryan A12ORCID,Snyder Kenneth V23,Mokin Maxim4,Waqas Muhammad23,Podgorsak Alexander R125,Allman Ariana B12,Senko Jillian12,Bhurwani Mohammad Mahdi Shiraz12,Hoi Yiemeng6,Davies Jason M237,Levy Elad I23,Siddiqui Adnan H23,Ionita Ciprian N1235ORCID

Affiliation:

1. Department of Biomedical Engineering, University at Buffalo, USA

2. Canon Stroke and Vascular Research Center, Buffalo, USA

3. Department of Neurosurgery, University at Buffalo, USA

4. Department of Neurosurgery, University of South Florida, Tampa, USA

5. Department of Medical Physics, University at Buffalo, USA

6. Canon Medical Systems USA Inc., Tustin, USA

7. Department of Bioinformatics, University at Buffalo, USA

Abstract

Computed tomography perfusion (CTP) is crucial for acute ischemic stroke (AIS) patient diagnosis. To improve infarct prediction, enhanced image processing and automated parameter selection have been implemented in Vital Images’ new CTP+ software. We compared CTP+ with its previous version, commercially available software (RAPID and Sphere), and follow-up diffusion-weighted imaging (DWI). Data from 191 AIS patients between March 2019 and January 2020 was retrospectively collected and allocated into endovascular intervention ( n = 81) and conservative treatment ( n = 110) cohorts. Intervention patients were treated for large vessel occlusion, underwent mechanical thrombectomy, and achieved successful reperfusion of thrombolysis in cerebral infarction 2b/2c/3. Conservative treatment patients suffered large or small vessel occlusion and did not receive intravenous thrombolysis or mechanical thrombectomy. Infarct and penumbra were assessed using intervention and conservative treatment patients, respectively. Infarct and penumbra volumes were segmented from CTP+ and compared with 24-h DWI along with RAPID, Sphere, and Vitrea. Mean infarct differences (95% confidence intervals) and Spearman correlation coefficients (SCCs) between DWI and each CTP software product for intervention patients are: CTP+  = (5.8 ± 5.9 ml, 0.62), RAPID = (10.0  ± 5.2 ml, 0.73), Sphere = (3.0 ± 6.0 ml, 0.56), Vitrea = (7.2 ± 4.9 ml, 0.66). For conservative treatment patients, mean infarct differences and SCCs are: CTP+ = (–8.0 ± 5.4 ml, 0.64), RAPID = (–25.6 ± 11.5 ml, 0.60), Sphere = (–25.6 ± 8.0 ml, 0.66), Vitrea = (1.3 ± 4.0 ml, 0.72). CTP+ performed similarly to RAPID and Sphere in addition to its semi-automated predecessor, Vitrea, when assessing intervention patient infarct volumes. For conservative treatment patients, CTP+ outperformed RAPID and Sphere in assessing penumbra. Semi-automated Vitrea remains the most accurate in assessing penumbra, but CTP+ provides an improved workflow from its predecessor.

Funder

Canon Medical Systems USA, Inc.

Publisher

SAGE Publications

Subject

Neurology (clinical),Radiology, Nuclear Medicine and imaging,General Medicine

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