Higher agreement in endovascular treatment decision-making than in parametric quantifications among automated CT perfusion software packages in acute ischemic stroke

Pérez-Pelegrí, Manuel; Biarnés, Carles; Thió‐Henestrosa, Santiago; Remollo, Sebastià; Gimeno, Alfredo; Cuba, Victor; Teceño, Mikel; Martí-Navas, Marian; Serena, Joaquı́n; Pedraza, Salvador; Ruiz-Constantino, Juan Sebastián; Puig, Josep

doi:10.3233/xst-210898

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…The second cluster ranging from 2019 to 2021 includes publications retrospectively analyzing CTP data from the major clinical trials concomitant with the development of MT, confirming the growing interest in imagingbased patients selection for reperfusion therapies (109)(110)(111). This time frame also shows an emergence of automated CTP imaging post-processing to provide target mismatch volume as well as infarct growth prediction (112)(113)(114)(115)(116).…”

Section: Penumbra Imaging In the Thrombectomy Eramentioning

confidence: 80%

Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy

Chalet

Boutelier

Christen

et al. 2022

Front. Cardiovasc. Med.

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The ischemic penumbra is defined as the severely hypoperfused, functionally impaired, at-risk but not yet infarcted tissue that will be progressively recruited into the infarct core. Early reperfusion aims to save the ischemic penumbra by preventing infarct core expansion and is the mainstay of acute ischemic stroke therapy. Intravenous thrombolysis and mechanical thrombectomy for selected patients with large vessel occlusion has been shown to improve functional outcome. Given the varying speed of infarct core progression among individuals, a therapeutic window tailored to each patient has recently been proposed. Recent studies have demonstrated that reperfusion therapies are beneficial in patients with a persistent ischemic penumbra, beyond conventional time windows. As a result, mapping the penumbra has become crucial in emergency settings for guiding personalized therapy. The penumbra was first characterized as an area with a reduced cerebral blood flow, increased oxygen extraction fraction and preserved cerebral metabolic rate of oxygen using positron emission tomography (PET) with radiolabeled O2. Because this imaging method is not feasible in an acute clinical setting, the magnetic resonance imaging (MRI) mismatch between perfusion-weighted imaging and diffusion-weighted imaging, as well as computed tomography perfusion have been proposed as surrogate markers to identify the penumbra in acute ischemic stroke patients. Transversal studies comparing PET and MRI or using longitudinal assessment of a limited sample of patients have been used to define perfusion thresholds. However, in the era of mechanical thrombectomy, these thresholds are debatable. Using various MRI methods, the original penumbra definition has recently gained a significant interest. The aim of this review is to provide an overview of the evolution of the ischemic penumbra imaging methods, including their respective strengths and limitations, as well as to map the current intellectual structure of the field using bibliometric analysis and explore future directions.

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Section: Penumbra Imaging In the Thrombectomy Eramentioning

confidence: 80%

Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy

Chalet

Boutelier

Christen

et al. 2022

Front. Cardiovasc. Med.

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“…A few comparative studies between other CTP software packages have also been reported. [17][18][19] A specific ICV or PV threshold is usually used clinically to select patients who may potentially benefit from EVT or MT treatment, but it has been difficult to reach a consensus on what the volume threshold should be. Thus, a possible approach is to assess the consistency of the software over a range of threshold intervals.…”

Section: Discussionmentioning

confidence: 99%

“…AccuCTP and RAPID share a similar processing flow, but there may be differences in image preprocessing and deconvolution solving. A few comparative studies between other CTP software packages have also been reported 17–19 …”

Section: Discussionmentioning

confidence: 99%

Computed tomography perfusion software pipelines to assess parameter maps and ischemic volumes: A comparative study

Lu,

Yao,

Yin

et al. 2023

Journal of Neuroimaging

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Background and PurposeThis study was dedicated to investigating the agreement of the calculated results of two CT perfusion (CTP) postprocessing software packages, including parameter maps and ischemic volume, focusing on the infarct core volume (ICV) and penumbra volume (PV).MethodsA retrospective collection of 235 patients with acute ischemic stroke who underwent CTP examination were enrolled. All images had been analyzed with two software pipelines, RAPID CTP and AccuCTP, and the comparative analysis was based on ICV and PV results calculated by both software packages. The agreement of parameter maps was evaluated by root mean square error and Bland‐Altman analysis. The ICV and PV agreement was evaluated by intraclass correlation coefficient (ICC) and Bland‐Altman analysis. The accuracy of ICV and PV based on multiple thresholds was also analyzed.ResultsThe ICV and PV of AccuCTP and RAPID CTP show excellent agreement. The relative differences of the parameter maps were all within 10% and the Bland‐Altman analysis also showed a strong agreement. From ordinary least squares fitting results, both ICV and PV had a remarkably high goodness of fit (ICV, R2= 0.975 [p<.001]; PV, R2= 0.964 [p<.001]). For the ICC analysis, both had high ICC scores (ICV ICC 0.984, 95% CI [confidence interval] 0.973‐0.989; PV ICC 0.955, 95% CI 0.947‐0.964). Furthermore, multi‐threshold analysis on the basis of ICV and PV also achieved reliable analytical accuracy.ConclusionsThe image analysis results of AccuCTP are in excellent agreement with RAPID CTP and can be used as an alternative analysis tool to RAPID CTP software in stroke clinical practice.

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“…However, at present, CTP or PWI examination and endovascular treatment of acute ischemic stroke are mostly completed in advanced stroke centers, which are mostly concentrated in large and medium-sized cities; this may also limit the wide application of RAPID software in China. Additionally, some studies have shown that, for the evaluation of hypoperfusion/infarction mismatch, the consistency of the evaluation conclusions of multiple software is more practical than the absolute parameter setting of a single software [ 28 ]. Several points remain to be improved during the application of the RAPID software: (1) The estimation of the total volume of the hypoperfusion area in existing studies was based on the Tmax data of perfusion imaging, and whether the patients beyond the treatment time window are applicable has not been verified.…”

Section: Development and Application Of Rapid Softwarementioning

confidence: 99%

The Application of Software “Rapid Processing of Perfusion and Diffusion” in Acute Ischemic Stroke

Zhang

Song

et al. 2022

Brain Sciences

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In the event of an acute ischemic stroke, saving the penumbra is the most important aspect of early treatment. The rapid and accurate identification of ischemic penumbra plays a key role in its comprehensive treatment. At present, the identification method and evaluation standard of ischemic penumbra have not been unified. Numerous pieces of software identifying ischemic penumbra have been developed, such as rapid processing of perfusion and diffusion (RAPID), Sphere, Vitrea, and computed tomography perfusion+ (CTP+). The RAPID software, analyzing and integrating multi-mode image data (mainly based on perfusion weighted imaging (PWI) or computed tomography perfusion (CTP) images, shows good performance in identifying ischemic penumbra and has been utilized for the assessment of ischemic penumbra in many ischemic stroke clinical studies, achieving good outcomes and promoting the transition from “time window” to “tissue window” in the treatment of early stage AIS. To obtain a comprehensive understanding of the RAPID software and its accuracy in evaluating ischemic penumbra, this paper reviews the background and development of the RAPID software, summarizes the published acute cerebral infarction trials using the RAPID software, generalizes the threshold parameters in different time windows, and further discusses its application and limitations.

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Higher agreement in endovascular treatment decision-making than in parametric quantifications among automated CT perfusion software packages in acute ischemic stroke

Cited by 8 publications

References 26 publications

Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy

Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy

Computed tomography perfusion software pipelines to assess parameter maps and ischemic volumes: A comparative study

The Application of Software “Rapid Processing of Perfusion and Diffusion” in Acute Ischemic Stroke

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