BACKGROUND AND OBJECTIVE:Estimates of parameters used to select patients for endovascular thrombectomy (EVT) for acute ischemic stroke differ among software packages for automated computed tomography (CT) perfusion analysis. To determine impact of these differences in decision making, we analyzed intra-observer and inter-observer agreement in recommendations about whether to perform EVT based on perfusion maps from 4 packages. METHODS:Perfusion CT datasets from 63 consecutive patients with suspected acute ischemic stroke were retrospectively postprocessed with 4 packages of Minerva, RAPID, Olea, and IntelliSpace Portal (ISP). We used Pearson correlation coefficients and Bland-Altman analysis to compare volumes of infarct core, penumbra, and mismatch calculated by Minerva and RAPID. We used kappa analysis to assess agreement among decisions of 3 radiologists about whether to recommend EVT based on maps generated by 4 packages. RESULTS:We found significant differences between using Minerva and RAPID to estimate penumbra (67.39±41.37mL vs. 78.35±45.38 mL, p < 0.001) and mismatch (48.41±32.03 vs. 61.27±32.73mL, p < 0.001), but not of infarct core (p = 0.230). Pearson correlation coefficients were 0.94 (95%CI:0.90–0.96) for infarct core, 0.87 (95%CI:0.79–0.91) for penumbra, and 0.72 (95%CI:0.57–0.83) for mismatch volumes (p < 0.001). Limits of agreements were (–21.22–25.02) for infarct core volumes, (–54.79–32.88) for penumbra volumes, and (–60.16–34.45) for mismatch volumes. Final agreement for EVT decision-making was substantial between Minerva vs. RAPID (k = 0.722), Minerva vs. Olea (k = 0.761), and RAPID vs. Olea (k = 0.782), but moderate for ISP vs. the other three. CONCLUSIONS:Despite quantitative differences in estimates of infarct core, penumbra, and mismatch using 4 software packages, their impact on radiologists’ decisions about EVT is relatively small.

中文翻译：

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在急性缺血性卒中的自动 CT 灌注软件包中，血管内治疗决策的一致性高于参数量化

背景和目的：用于选择急性缺血性卒中血管内血栓切除术 (EVT) 患者的参数估计值在用于自动计算机断层扫描 (CT) 灌注分析的软件包中有所不同。为了确定这些差异对决策制定的影响，我们分析了观察者内和观察者间的一致性，以建议是否基于 4 个包的灌注图执行 EVT。方法：用 Minerva、RAPID、Olea 和 IntelliSpace Portal (ISP) 的 4 个软件包对 63 例疑似急性缺血性卒中连续患者的灌注 CT 数据集进行回顾性后处理。我们使用 Pearson 相关系数和 Bland-Altman 分析来比较 Minerva 和 RAPID 计算的梗塞核心、半影和错配的体积。我们使用 kappa 分析来评估 3 位放射科医生根据 4 个软件包生成的地图是否推荐 EVT 的决定之间的一致性。结果：我们发现使用 Minerva 和 RAPID 估计半影带（67.39±41.37mL vs. 78.35±45.38 mL，p < 0.001）和错配（48.41±32.03 vs. 61.27±32.73mL，p <0.001）之间存在显着差异，但不是梗死核心 (p = 0.230)。梗死核心的 Pearson 相关系数为 0.94 (95%CI:0.90–0.96)，半影区为 0.87 (95%CI:0.79–0.91)，错配体积为 0.72 (95%CI:0.57–0.83) (p < 0.001) . 梗死核心体积的协议限制为 (–21.22–25.02)，半影体积为 (–54.79–32.88)，错配体积为 (–60.16–34.45)。在 Minerva 与 RAPID (k = 0.722)、Minerva 与 Olea (k = 0.761) 以及 RAPID 与 Olea (k = 0.782)，但 ISP 与其他三个相比适中。结论：尽管使用 4 个软件包对梗死核心、半影和错配的估计存在定量差异，但它们对放射科医生关于 EVT 的决定的影响相对较小。