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A Comparative Study of CT Perfusion Postprocessing Tools in Medium/Distal Vessel Occlusion Stroke.

Helene Corbaz¹, Nikolaos Ntoulias², Alex Brehm²

¹From the Department of Biomedical Engineering (H.C., J.W., P.C.C., F.B.), University Basel, Basel, Switzerland.

AJNR. American Journal of Neuroradiology

|April 24, 2025

Summary

Commercial computed tomography perfusion (CTP) postprocessing tools show significant discrepancies in medium or distal vessel occlusion (MDVO) stroke patients. These differences impact lesion volume and distribution assessments, affecting clinical decision-making.

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Area of Science:

Neurology
Radiology
Medical Imaging

Background:

Computed tomography perfusion (CTP) is validated for large vessel occlusion stroke.
Its accuracy for medium or distal vessel occlusions (MDVO) is less established.
Discrepancies in CTP postprocessing tools may affect MDVO stroke management.

Purpose of the Study:

To evaluate discrepancies between two widely used CTP postprocessing tools.
To assess the agreement in lesion volume and spatial distribution for MDVO stroke.
To compare penumbra volumes calculated by different CTP software.

Main Methods:

Retrospective single-center cohort study of acute isolated MDVO stroke patients.
Comparison of CTP data processed by Syngo.via and RapidAI.
Segmentation and analysis of perfusion lesions, infarct core, and penumbra volumes.
Statistical comparison of volume and spatial distribution agreement.

Main Results:

Agreement criteria met in less than 30% of patients.
Disagreement on tissue-at-risk volume and distribution in up to 79.6%.
Infarct core presence and volume disagreed in up to 86% of cases.
Significant differences in penumbra volumes between tools (P < .001).

Conclusions:

Commercially available CTP postprocessing tools yield discrepant results in MDVO stroke.
These discrepancies highlight potential limitations in current CTP analysis for MDVO.
Further standardization or validation of CTP tools for MDVO is warranted.