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Published on: May 30, 2011
Automated MRI perfusion-diffusion mismatch estimation may be significantly different in individual patients when
Hannes Deutschmann1, Nicole Hinteregger1, Ulrike Wießpeiner1
1Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria.
Objective:
To compare two established software applications in terms of apparent diffusion coefficient (ADC) lesion volumes, volume of critically hypoperfused brain tissue, and calculated volumes of perfusion-diffusion mismatch in brain MRI of patients with acute ischemic stroke.
Methods:
Brain MRI examinations of 81 patients with acute stroke due to large vessel occlusion of the anterior circulation were analyzed. The volume of hypoperfused brain tissue, ADC volume, and the volume of perfusion-diffusion mismatch were calculated automatically with two different software packages. The calculated parameters were compared quantitatively using formal statistics.
Results:
Significant difference was found for the volume of hypoperfused tissue (median 91.0 ml vs. 102.2 ml; p < 0.05) and the ADC volume (median 30.0 ml vs. 23.9 ml; p < 0.05) between different software packages. The volume of the perfusion-diffusion mismatch differed significantly (median 47.0 ml vs. 67.2 ml; p < 0.05). Evaluation of the results on a single-subject basis revealed a mean absolute difference of 20.5 ml for hypoperfused tissue, 10.8 ml for ADC volumes, and 27.6 ml for mismatch volumes, respectively. Application of the DEFUSE 3 threshold of 70 ml infarction core would have resulted in dissenting treatment decisions in 6/81 (7.4%) patients.
Conclusion:
Volume segmentation in different software products may lead to significantly different results in the individual patient and may thus seriously influence the decision for or against mechanical thrombectomy.
Key Points:
• Automated calculation of MRI perfusion-diffusion mismatch helps clinicians to apply inclusion and exclusion criteria derived from randomized trials. • Infarct volume segmentation plays a crucial role and lead to significantly different result for different computer programs. • Perfusion-diffusion mismatch estimation from different computer programs may influence the decision for or against mechanical thrombectomy.
Insights
Different MRI software significantly alters acute stroke volume calculations, potentially impacting treatment decisions for mechanical thrombectomy. Accurate infarct core and perfusion-diffusion mismatch assessment is crucial for patient care.
Area of Science:
- Neuroradiology
- Medical Imaging Analysis
- Stroke Imaging
Background:
- Accurate assessment of brain tissue viability is critical in acute ischemic stroke management.
- Perfusion-diffusion mismatch quantifies the difference between hypoperfused brain tissue and infarct core, guiding treatment decisions.
- Established software applications are used for automated analysis of MRI data in stroke patients.
Purpose of the Study:
- To compare the performance of two established software applications in calculating apparent diffusion coefficient (ADC) lesion volumes.
- To evaluate differences in the calculated volumes of critically hypoperfused brain tissue and perfusion-diffusion mismatch.
- To assess the impact of software variability on clinical decision-making for mechanical thrombectomy.
Main Methods:
- Analysis of brain MRI scans from 81 patients with acute ischemic stroke due to large vessel occlusion.
- Automated calculation of hypoperfused tissue volume, ADC volume, and perfusion-diffusion mismatch using two distinct software packages.
- Quantitative statistical comparison of parameters derived from the different software applications.
Main Results:
- Significant differences were observed in calculated volumes of hypoperfused tissue (median 91.0 vs. 102.2 ml) and ADC lesion volume (median 30.0 vs. 23.9 ml) between the software packages (p < 0.05).
- Perfusion-diffusion mismatch volumes also differed significantly (median 47.0 vs. 67.2 ml; p < 0.05).
- Mean absolute differences per patient were 20.5 ml for hypoperfused tissue, 10.8 ml for ADC volumes, and 27.6 ml for mismatch volumes; applying the DEFUSE 3 threshold could lead to dissenting treatment decisions in 7.4% of cases.
Conclusions:
- Volume segmentation using different software products can yield significantly different results at the individual patient level.
- These discrepancies in infarct core and mismatch volumes may critically influence the decision for or against mechanical thrombectomy.
- Automated calculation of perfusion-diffusion mismatch aids in applying trial-derived inclusion/exclusion criteria, but software variability necessitates careful consideration.
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