Automated MRI perfusion-diffusion mismatch estimation may be significantly different in individual patients when using different software packages

Deutschmann, Hannes; Hinteregger, Nicole; Wießpeiner, Ulrike; Kneihsl, Markus; Fandler‐Höfler, Simon; Michenthaler, Manuela; Enzinger, Christian; Hassler, Eva; Leber, Stefan; Reishofer, Gernot

doi:10.1007/s00330-020-07150-8

Cited by 24 publications

(20 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This observation was made for AIS patients with anterior circulation LVO admitted either in the early or in late time window who underwent EVT. This is in line with the study by Deutschmann et al [15] who compared RAPID® and Olea Sphere® software and reported that RAPID® outlines slightly larger ADC and smaller hypoperfused tissue volumes. They considered that small differences of the outlined regions in single slices can sum up to considerable differences in 3D volumes.…”

Section: Discussionsupporting

confidence: 92%

“…Xiong et al [14] compared two automated CT perfusion software (RAPID® and Olea Sphere®) for evaluation of AIS patients, showing that core volumes calculated with RAPID® were larger than with Olea Sphere®. The only report about MR perfusion software actually available, recently published by Deutschmann et al [15], compared RAPID® and Olea Sphere® software. They reported a small systematic difference between software, in the sense that RAPID® outlines slightly larger ADC and smaller hypoperfused tissue volumes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

MRI software for diffusion-perfusion mismatch analysis may impact on patients’ selection and clinical outcome

et al. 2021

View full text Add to dashboard Cite

Objective Impact of different MR perfusion software on selection and outcome of patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO) treated by endovascular thrombectomy (EVT) is unclear. We aimed at comparing two commercial MRI software, semi-automated with unadjusted (method A) and adjusted mask (method B), and fully automated (method C) in this setting. Methods MRI from 144 consecutive AIS patients with anterior circulation LVO was retrospectively analysed. All diffusion- and perfusion-weighted images (DWI-PWI) were post-processed with the three methods using standard thresholds. Concordance for core and hypoperfusion volumes was assessed with Lin’s test. Clinical outcome was compared between groups in patients who underwent successful EVT in the early and late time window. Results Mean core volume was higher and mean hypoperfusion volume was lower in method C than in methods A and B. In the early time window, methods A and B found fewer patients with a mismatch ratio ≤ 1.2 than method C (1/67 [1.5%] vs. 12/67 [17.9%], p = 0.0013). In the late time window, methods A and B found fewer patients with a mismatch ratio < 1.8 than method C (3/46 [6.5%] and 2/46 [4.3%] vs. 18/46 [39.1%], p ≤ 0.0002). More patients with functional independence at 3 months would not have been treated using method C versus methods A and B in the early (p = 0.0063) and late (p ≤ 0.011) time window. Conclusions MRI software for DWI-PWI analysis may influence patients’ selection before EVT and clinical outcome. Key Points • Method C detects fewer patients with favourable mismatch profile. • Method C might underselect more patients with functional independence at 3 months. • Software used before thrombectomy may influence patients’ outcome.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

MRI software for diffusion-perfusion mismatch analysis may impact on patients’ selection and clinical outcome

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The ADC lesion volume estimated by the RAPID software is likely significantly larger than that by Olea Sphere, despite the linear relationship between the volumes measured with the two softwares. 38 Thus, as the Olea Sphere evaluated ADC 620 may underestimate diffusion-positive lesion volume, the role of ADC 540 /ADC 620 ratios measured by other software, including RAPID, needs to be further investigated. Another concern is the timing (≈5–7 days after EVT) and imaging modalities used for measurement of the final infarct volume.…”

Section: Discussionmentioning

confidence: 99%

Role of Apparent Diffusion Coefficient Gradient Within Diffusion Lesions in Outcomes of Large Stroke After Thrombectomy

Gwak

Choi

Shim

et al. 2022

Stroke

View full text Add to dashboard Cite

Background and Purpose: The outcome of endovascular treatment in stroke patients with a large ischemic core is not always satisfactory. We evaluated whether the severity of baseline diffusion-weighted imaging abnormalities, as assessed by different apparent diffusion coefficient (ADC) thresholds, correlates with the clinical outcome in these patients after successful endovascular treatment. Methods: In 82 consecutive patients with a large vessel occlusion in the anterior circulation admitted ≤24 hours after onset, a baseline diffusion lesion volume (ADC ≤620×10 −6 mm 2 /s [ADC 620 ]) ≥50 mL and successful recanalization by endovascular treatment were retrospectively investigated. Lesion volumes of 3 ADC thresholds (ADC 620 , ADC ≤520×10 − 6 mm 2 /s [ADC 520 ], and ADC ≤540×10 −6 mm 2 /s [ADC 540 ]) were measured using an automated Olea software program. The performance of the ADC 520 /ADC 620 and ADC 540 /ADC 620 ratios in predicting the functional outcome was assessed by receiver operating characteristic curve analysis. The ADC ratio with optimal threshold showing better receiver operating characteristic performance was dichotomized at its median value into low versus high subgroup and its association with the outcome subsequently evaluated in a multivariable logistic regression model. Results: The median baseline diffusion lesion volume was 80.8 mL (interquartile range, 64.4–105.4). A good functional outcome (modified Rankin Scale score, ≤2) was achieved in 35 patients (42.7%). The optimal threshold for predicting the functional outcome was identified as ADC 540 /ADC 620 (area under the curve, 0.833) and dichotomized at 0.674. After adjusting for age, baseline National Institutes of Health Stroke Scale score, intravenous tissue-type plasminogen activator, baseline diffusion lesion volume, and onset-to-recanalization time, a low ADC 540 /ADC 620 was independently associated with a good functional outcome (adjusted odds ratio, 10.72 [95% CI, 3.06–37.50]; P <0.001). Conclusions: A low ADC 540 /ADC 620 , which may reflect less severe ischemic stress inside a diffusion lesion, may help to identify patients who would benefit from endovascular treatment despite having a large ischemic core.

show abstract

“…It is thus unknown to what extent different software applications agree regarding the same anatomical areas [ 35 ]. This issue is not only of academic interest, as volume segmentation in different software products may lead to significantly different results in the individual patient and may thus seriously influence therapeutic decisions, as was recently shown for automated MRI perfusion-diffusion mismatch volume estimation and the consecutive decision for or against mechanical thrombectomy [ 36 ]. In this study, we therefore investigated the quantitative agreement between well-established volumetric applications in a well-separated cohort and found major differences.…”

Section: Discussionmentioning

confidence: 99%

Qualitative and Quantitative Comparison of Hippocampal Volumetric Software Applications: Do All Roads Lead to Rome?

et al. 2022

View full text Add to dashboard Cite

Brain volumetric software is increasingly suggested for clinical routine. The present study quantifies the agreement across different software applications. Ten cases with and ten gender- and age-adjusted healthy controls without hippocampal atrophy (median age: 70; 25–75% range: 64–77 years and 74; 66–78 years) were retrospectively selected from a previously published cohort of Alzheimer’s dementia patients and normal ageing controls. Hippocampal volumes were computed based on 3 Tesla T1-MPRAGE-sequences with FreeSurfer (FS), Statistical-Parametric-Mapping (SPM; Neuromorphometrics and Hammers atlases), Geodesic-Information-Flows (GIF), Similarity-and-Truth-Estimation-for-Propagated-Segmentations (STEPS), and Quantib™. MTA (medial temporal lobe atrophy) scores were manually rated. Volumetric measures of each individual were compared against the mean of all applications with intraclass correlation coefficients (ICC) and Bland–Altman plots. Comparing against the mean of all methods, moderate to low agreement was present considering categorization of hippocampal volumes into quartiles. ICCs ranged noticeably between applications (left hippocampus (LH): from 0.42 (STEPS) to 0.88 (FS); right hippocampus (RH): from 0.36 (Quantib™) to 0.86 (FS). Mean differences between individual methods and the mean of all methods [mm3] were considerable (LH: FS −209, SPM-Neuromorphometrics −820; SPM-Hammers −1474; Quantib™ −680; GIF 891; STEPS 2218; RH: FS −232, SPM-Neuromorphometrics −745; SPM-Hammers −1547; Quantib™ −723; GIF 982; STEPS 2188). In this clinically relevant sample size with large spread in data ranging from normal aging to severe atrophy, hippocampal volumes derived by well-accepted applications were quantitatively different. Thus, interchangeable use is not recommended.

show abstract

Automated MRI perfusion-diffusion mismatch estimation may be significantly different in individual patients when using different software packages

Cited by 24 publications

References 25 publications

MRI software for diffusion-perfusion mismatch analysis may impact on patients’ selection and clinical outcome

MRI software for diffusion-perfusion mismatch analysis may impact on patients’ selection and clinical outcome

Role of Apparent Diffusion Coefficient Gradient Within Diffusion Lesions in Outcomes of Large Stroke After Thrombectomy

Qualitative and Quantitative Comparison of Hippocampal Volumetric Software Applications: Do All Roads Lead to Rome?

Contact Info

Product

Resources

About