Comparative validation of automated perfusion analysis software for ischemic penumbra estimation and EVT...

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Magnetic resonance perfusion-weighted imaging (PWI) offers superior spatial resolution and tissue specificity compared to CT perfusion for acute stroke imaging.
• Combining PWI with diffusion-weighted imaging (DWI) enhances diagnostic accuracy in stroke assessment.
• No systematic comparison of automated PWI analysis platforms has been previously conducted.

Purpose of the Study:

• To evaluate the performance of a new automated PWI software, JLK PWI.
• To compare JLK PWI against the established RAPID platform.
• To assess volumetric agreement and clinical decision concordance between the two PWI analysis platforms.

Main Methods:

• A retrospective multicenter study included 299 acute ischemic stroke patients.
• Perfusion-weighted imaging (PWI) was performed within 24 hours of symptom onset.
• Volumetric agreement was assessed using concordance correlation coefficients (CCC) and Bland-Altman plots.
• Endovascular therapy (EVT) eligibility was evaluated based on DAWN and DEFUSE-3 criteria using Cohen's kappa.

Main Results:

• JLK PWI demonstrated excellent agreement with RAPID for ischemic core (CCC=0.87) and hypoperfused volume (CCC=0.88).
• High concordance was observed for EVT eligibility using DAWN criteria (kappa=0.80-0.90).
• Substantial agreement was found using DEFUSE-3 criteria (kappa=0.76).

Conclusions:

• JLK PWI exhibits high technical and clinical concordance with the RAPID platform.
• The findings support JLK PWI as a dependable alternative for MRI-based perfusion analysis in acute stroke.
• This facilitates more accurate and timely treatment decisions in stroke care.