Comparison of CT Perfusion Software Packages for Thrombectomy Eligibility

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Computed tomography perfusion (CTP) is crucial for selecting acute ischemic stroke patients for mechanical thrombectomy (MT).
• Accurate estimation of ischemic core volume is vital for treatment decisions.

Purpose of the Study:

• To evaluate the agreement between three CTP software packages: RAPID, Viz CTP, and e-CTP.
• To compare their ability to estimate baseline ischemic core volumes in patients with near-complete/complete reperfusion after MT.

Main Methods:

• Retrospective analysis of 242 patients with anterior circulation large vessel occlusion strokes (LVOS).
• Comparison of perfusion parametric maps (relative cerebral blood flow and time to maximum of the residue function) from RAPID, Viz CTP, and e-CTP.
• Assessment of agreement in predicting final infarct volume (FIV) in patients with expanded thrombolysis in cerebral infarction (eTICI) 2c-3 reperfusion.

Main Results:

• Substantial agreement was observed between RAPID and Viz CTP (ρ=0.767) and RAPID and e-CTP (ρ=0.668) for relative cerebral blood flow < 30%.
• Excellent agreement was found between RAPID and Viz CTP (ρ=0.811) for time to maximum of the residue function > 6 seconds, with substantial agreement for RAPID and e-CTP (ρ=0.749).
• All three software packages demonstrated substantial agreement in predicting final infarct volume (RAPID ρ=0.744, Viz CTP ρ=0.711, e-CTP ρ=0.600).

Conclusions:

• Perfusion parametric maps generated by RAPID, Viz CTP, and e-CTP software show substantial agreement.
• This agreement extends to the prediction of final infarct volume in patients with acute ischemic stroke who achieve near-complete or complete reperfusion.
• The findings support the reliability of these software packages for consistent patient selection in mechanical thrombectomy.