Baseline Cerebral Ischemic Core Quantified by Different Automatic Software and Its Predictive Value for Clinical...

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute ischemic stroke requires timely intervention.
• Endovascular thrombectomy (EVT) is a key treatment for acute ischemic stroke.
• Accurate measurement of ischemic core volume (ICV) and penumbra volume (PV) is crucial for guiding EVT.

Purpose of the Study:

• To compare the agreement of three software packages (ISP, RAPID, F-STROKE) in measuring baseline ICV and PV.
• To evaluate the predictive value of these measurements for unfavorable clinical outcomes after EVT.

Main Methods:

• Patients with acute ischemic stroke undergoing computed tomographic perfusion (CTP) were analyzed.
• ICV and PV were calculated using ISP, RAPID, and F-STROKE software.
• Clinical outcomes were assessed using the modified Rankin scale (mRS) at 90 days post-EVT.
• Agreement was determined by intraclass correlation coefficient (ICC); predictive values by logistic regression and ROC analysis.

Main Results:

• Excellent agreement was found between F-STROKE and RAPID for both ICV (ICC 0.965) and PV (ICC 0.966).
• ICV measurements from all three software packages were significantly associated with unfavorable outcomes.
• F-STROKE and RAPID demonstrated superior predictive performance (AUC 0.701-0.717) compared to ISP (AUC 0.629) for unfavorable outcomes.

Conclusions:

• F-STROKE software demonstrates excellent agreement with RAPID for CTP-based ICV and PV measurements.
• ICV measured by F-STROKE and RAPID are strong predictors of unfavorable clinical outcomes following EVT, outperforming ISP.