Purpose

Perfusion imaging generates multimaps of ischemic tissues and is a proven decision-making tool in patients with acute ischemic stroke. However, the reliability of perfusion post-processing outcomes has been debated, given disparate results of various software applications, especially for patients with small ischemic core volume. This study was undertaken to compare ischemic volume estimates determined by imSTROKE (a software with new imaging protocol) and RAPID computer applications, respectively.

Methods

A total of 611 patients qualified for study, each having met inclusion and exclusion criteria of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN trial). Subjects were examined by computed tomography perfusion (CTP) imaging (n = 349) or perfusion-weighted (PWI) and diffusion-weighted (DWI) imaging (n = 262). Ischemic volumes estimated by imSTROKE and RAPID applications were then compared. We used Bland-Altman analysis and intraclass correlation coefficients (ICCs) to ascertain agreement between applications. Accuracies of estimated core infarct and penumbra volumes were tested at specific thresholds (core: 25 mL, 50 mL, and 70 mL; penumbra: 45 mL, 90 mL, and 125 mL).

Results

Median core infarct volumes by imSTROKE and RAPID were 29.18 mL and 29.53 mL, respectively (ICC = 0.9880, 95% confidence interval [CI]: 0.9860–0.9898). Median penumbra volumes by imSTROKE and RAPID were 68.20 mL and 68.55 mL, respectively (ICC = 0.9885, 95% CI: 0.9865–0.9902).

Conclusion

In estimating core infarct and penumbra volumes, imSTROKE and RAPID applications showed high-level agreement. For patients with small ischemic core volume, compared with RAPID, imSTROKE may have better sensitivity.

中文翻译：

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现实世界中急性缺血性脑卒中患者脑灌注图像处理软件的两种比较

目的

灌注成像生成缺血组织的多图，是急性缺血性中风患者的一种行之有效的决策工具。然而，鉴于各种软件应用程序的不同结果，尤其是对于缺血核心体积较小的患者，灌注后处理结果的可靠性一直存在争议。本研究旨在比较分别由 imSTROKE（具有新成像协议的软件）和 RAPID 计算机应用程序确定的缺血体积估计值。

方法

共有 611 名患者符合研究条件，每名患者均符合荷兰急性缺血性卒中血管内治疗多中心随机临床试验（MR CLEAN 试验）的纳入和排除标准。通过计算机断层扫描灌注 (CTP) 成像 ( n = 349) 或灌注加权 (PWI) 和弥散加权 (DWI) 成像 ( n = 262)检查受试者。然后比较由 imSTROKE 和 RAPID 应用程序估计的缺血体积。我们使用 Bland-Altman 分析和类内相关系数 (ICC) 来确定应用程序之间的一致性。在特定阈值（核心：25 毫升、50 毫升和 70 毫升；半暗带：45 毫升、90 毫升和 125 毫升）下测试了估计的核心梗塞和半影体积的准确性。

结果

imSTROKE 和 RAPID 的中位核心梗死体积分别为 29.18 mL 和 29.53 mL（ICC = 0.9880，95% 置信区间 [CI]：0.9860–0.9898）。imSTROKE 和 RAPID 的中位半影体积分别为 68.20 mL 和 68.55 mL（ICC = 0.9885，95% CI：0.9865–0.9902）。

结论

在估计核心梗塞和半影体积时，imSTROKE 和 RAPID 应用程序表现出高度一致。对于缺血核心体积较小的患者，与 RAPID 相比，imSTROKE 可能具有更好的敏感性。