A New Automated Software for Enhanced Computed Tomography Perfusion Volume Assessment

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute ischemic stroke (AIS) requires rapid and accurate assessment of infarct core and penumbra.
• Computed tomography perfusion (CTP) is crucial for evaluating tissue viability and guiding reperfusion therapy.
• Existing CTP analysis software can be time-consuming and operator-dependent.

Purpose of the Study:

• To evaluate the predictive value of a novel automated CTP software, UKIT, for infarct outcomes in AIS.
• To compare UKIT's perfusion volume assessments with those of MIStar, a widely used CTP software.
• To assess UKIT's reliability in determining ischemic core and hypoperfusion volumes.

Main Methods:

• Retrospective analysis of CTP data from 278 AIS patients undergoing pre-reperfusion therapy.
• Comparison of ischemic core and hypoperfusion volumes between UKIT and MIStar using Spearman correlation, Bland-Altman plots, and kappa tests.
• Validation of UKIT's ischemic core volume assessment against ground truth in patients achieving successful recanalization after endovascular treatment (EVT).

Main Results:

• UKIT demonstrated strong correlation and agreement with MIStar for both ischemic core (r=0.982, ICC=0.902) and hypoperfusion volumes (r=0.979, ICC=0.956).
• Excellent agreement was observed between UKIT and MIStar based on imaging criteria in EXTEND and DEFFUSE 3 trials (kappa=0.73).
• UKIT's ischemic core volume assessment closely agreed with ground truth in EVT patients (r=0.695), comparable to MIStar (r=0.721).

Conclusions:

• The automated CTP software UKIT reliably quantifies ischemic core and hypoperfusion volumes in AIS patients.
• UKIT's accuracy and efficiency support its use in clinical decision-making for reperfusion therapy.
• UKIT shows potential to improve the selection and management of AIS patients.