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

Article type: Research Article

Authors: Pérez-Pelegrí, Manuel^a | Biarnés, Carles^b | Thió-Henestrosa, Santiago^c | Remollo, Sebastià^d | Gimeno, Alfredo^e | Cuba, Víctor^f | Teceño, Mikel^g | Martí-Navas, Marian^b | Serena, Joaquín^g | Pedraza, Salvador^b | Ruiz-Constantino, Juan Sebastián^a | Puig, Josep^{b; *}

Affiliations: [a] Lincbiotech SL, Parque Tecnológico de Galicia, Ourense, Spain | [b] Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute, (IDIBGI), Dr Josep Trueta University Hospital, Girona, Spain | [c] Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain | [d] Department of Radiology, Germans Triasi Pujol University Hospital, Badalona, Spain | [e] Department of Radiology, Vall d’Hebron University Hospital, Barcelona, Spain | [f] Department of Radiology, Bellvitge University Hospital, Barcelona, Spain | [g] Department of Neurology-IDIBGI, Dr Josep Trueta University Hospital, Girona, Spain

Correspondence: [*] Corresponding author: Josep Puig, MD, PhD, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona, Dr Josep Trueta University Hospital, Girona, Spain. E-mail: jpuigmd@gmail.com.

Abstract: BACKGROUND AND OBJECTIVE:Estimates of parameters used to select patients for endovascular thrombectomy (EVT) for acute ischemic stroke differ among software packages for automated computed tomography (CT) perfusion analysis. To determine impact of these differences in decision making, we analyzed intra-observer and inter-observer agreement in recommendations about whether to perform EVT based on perfusion maps from 4 packages. METHODS:Perfusion CT datasets from 63 consecutive patients with suspected acute ischemic stroke were retrospectively postprocessed with 4 packages of Minerva, RAPID, Olea, and IntelliSpace Portal (ISP). We used Pearson correlation coefficients and Bland-Altman analysis to compare volumes of infarct core, penumbra, and mismatch calculated by Minerva and RAPID. We used kappa analysis to assess agreement among decisions of 3 radiologists about whether to recommend EVT based on maps generated by 4 packages. RESULTS:We found significant differences between using Minerva and RAPID to estimate penumbra (67.39±41.37mL vs. 78.35±45.38 mL, p < 0.001) and mismatch (48.41±32.03 vs. 61.27±32.73mL, p < 0.001), but not of infarct core (p = 0.230). Pearson correlation coefficients were 0.94 (95%CI:0.90–0.96) for infarct core, 0.87 (95%CI:0.79–0.91) for penumbra, and 0.72 (95%CI:0.57–0.83) for mismatch volumes (p < 0.001). Limits of agreements were (–21.22–25.02) for infarct core volumes, (–54.79–32.88) for penumbra volumes, and (–60.16–34.45) for mismatch volumes. Final agreement for EVT decision-making was substantial between Minerva vs. RAPID (k = 0.722), Minerva vs. Olea (k = 0.761), and RAPID vs. Olea (k = 0.782), but moderate for ISP vs. the other three. CONCLUSIONS:Despite quantitative differences in estimates of infarct core, penumbra, and mismatch using 4 software packages, their impact on radiologists’ decisions about EVT is relatively small.

Keywords: Acute ischemic stroke, computed tomography perfusion (CTP), endovascular thrombectomy (EVT), estimates of infarct core, penumbra and mismatch

DOI: 10.3233/XST-210898

Journal: Journal of X-Ray Science and Technology, vol. 29, no. 5, pp. 823-834, 2021