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Achieving comparable perfusion results across vendors. The next step in standardizing stroke care: a technical report
  1. Girish Bathla1,
  2. Kaustubh Limaye2,
  3. Bruno Policeni1,
  4. Ernst Klotz3,
  5. Markus Juergens3,
  6. Colin Derdeyn4
  1. 1 Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2 Neurology, University of Iowa, Iowa City, Iowa, USA
  3. 3 Siemens Healthineers, Forchheim, Germany
  4. 4 Radiology and Interventional Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Girish Bathla, Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, IA 52242, USA; girish-bathla{at}


Background The role of mechanical thrombectomy in acute ischemic stroke (AIS) has been further expanded by recent trials which relied on the results of CT perfusion (CTP) imaging. However, CTP parameters for ischemia and infarct can vary significantly across different vendors.

Methods We compared the outcomes of the Siemens CTP software against the clinically validated RAPID software in 45 consecutive patients with suspected AIS. Both perfusion softwares initially processed images using vendor defined parameters for hypoperfusion and non-viable tissue. The software thresholds on the Siemens software were decrementally altered to see if concordant results between softwares could be attained.

Results At baseline settings, the mean values for core infarct and hypoperfusion were different (mean of 30/69 mL, respectively, for RAPID and 49/77 mL for Siemens). However, reducing the threshold values for the later software showed a concordance of values at a relative cerebral blood flow <20%, with resulting core infarct and hypoperfusion volumes at 31/69 mL, respectively, for the Siemens software. A Wilcoxon paired test showed no significant difference between the calculated core infarct and hypoperfusion values, both for the entire population as well as for the subgroup of patients with large vessel occlusion.

Conclusion Equivalent CTP results between vendor softwares may be attainable by altering the thresholds for hypoperfused and non-viable tissue, despite differences in acquisition techniques, post-processing, and scanners.

  • stroke
  • Ct perfusion
  • technique
  • brain

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  • Contributors Guarantor of integrity of the entire study: GB, CD, and EK. Study concepts and design: GB, CD, and BP. Literature research: GB, EK, and KL. Experimental studies/data analysis: GB, EK, MJ, and KL. Statistical analysis: EK, MJ, and GB. Manuscript preparation: GB, BP, and CD. Manuscript editing: GB, CD, EK, and KL.

  • Funding The department has a research agreement with Siemens AG, Forchheim, Germany. The study was funded through a research grant under the agreement.

  • Competing interests EK and MJ are full time employees of Siemens AG, Forchheim, Germany.

  • Ethics approval The study was approved by the local institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data may be made available from the corresponding authors upon reasonable request.

  • Presented at Accepted as an abstract for ASNR 2019.

  • Patient consent for publication Not required.