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Differences in CT perfusion summary maps for patients with acute ischemic stroke generated by 2 software packages.

F Fahmi¹, H A Marquering, G J Streekstra

¹Departments of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands. f.fahmi@amc.uva.nl

AJNR. American Journal of Neuroradiology

|May 5, 2012

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CT perfusion (CTP) analysis software shows significant variability in determining infarct core and penumbra areas. This highlights the need for standardized CTP analysis methods for acute ischemic stroke treatment decisions.

Area of Science:

Neuroimaging
Radiology
Stroke Imaging

Background:

CT perfusion (CTP) is a valuable tool for acute ischemic stroke treatment decisions.
Current CTP analysis lacks standardized methodologies.
Variability in CTP analysis can impact clinical management.

Purpose of the Study:

To assess the variability of infarct core and penumbra areas.
To compare summary maps generated by two different CTP software packages.
To evaluate agreement between delay-sensitive and delay-insensitive algorithms.

Main Methods:

Retrospective analysis of 41 CTP datasets from 26 acute ischemic stroke patients.
Comparison of two commercial CTP analysis software packages.
Bland-Altman analysis to assess agreement in infarct and penumbra area measurements.

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Main Results:

Statistically significant differences were found in infarct core (-23.6 ± 25.6 cm²) and penumbra area (15.8 ± 25.3 cm²).
Bland-Altman limits of agreement exceeded 100 cm² for all measured areas.
The two software packages demonstrated considerable variability in CTP analysis.

Conclusions:

Significant differences exist in CTP summary maps generated by common software.
Standardization and validation of CTP analysis are crucial.
Current CTP analysis variability necessitates caution in clinical application for stroke management.