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Comparing the outcomes of two independent computed tomography perfusion softwares and their impact on therapeutic decisions in acute ischemic stroke
  1. Girish Bathla1,
  2. Santiago Ortega-Gutierrez2,
  3. Ernst Klotz3,
  4. Markus Juergens3,
  5. Cynthia B Zevallos4,
  6. Sameer Ansari4,
  7. Caitlin E Ward5,
  8. Bruno Policeni1,
  9. Edgar Samaniego2,
  10. Colin Derdeyn6
  1. 1 Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2 Neurology, Division of Neurointerventional Surgery, University of Iowa, Iowa City, Iowa, USA
  3. 3 SHS DI CT R&D CTC SA, Siemens Healthineers, Forchheim, Germany
  4. 4 Neurology, University of Iowa, Iowa City, Iowa, USA
  5. 5 Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
  6. 6 Radiology, Division of Neurointerventional Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Girish Bathla, Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; girish-bathla{at}


Background To compare the computed tomography perfusion (CTP) outcomes derived from two commercial CTP processing software and evaluate their concordance in terms of eligibility for mechanical thrombectomy (MT) in acute ischemic stroke (AIS), based on DEFUSE III criteria.

Methods A total of 118 patients (62 patients in the MT group and 56 patients in the non-MT (NMT) group) were included. Volumetric perfusion outputs were compared between Syngo.via (package A) and RAPID (package B). Influence on proceeding or not-proceeding with MT was based on DEFUSE III imaging eligibility criteria.

Results Median core infarct/hypoperfusion volumes were 12.3/126 mL in the MT group and 7.7/29.3 ml in the NMT group with package A and 10.5/138 mL and 1.9/24.5 mL with package B, respectively. In the MT group (n=62), concordant perfusion results in terms of patient triage were noted in all but two cases. Of these, one patient would not have qualified (low ASPECTS), while the other qualified based on package A results. For the NMT group (n=56), there was discordance in terms of MT eligibility in seven cases. However, none of these patients qualified for MT based on DEFUSE III criteria.

Conclusions Both perfusion softwares showed high concordance in correctly triaging patients in the MT versus NMT groups (110/118, 93.2%), which further improved when all DEFUSE III imaging criteria were considered (117/118, 99.1%). The core/hypoperfusion volumes in the NMT group and core infarct volumes in the MT groups were comparable. The hypoperfusion volumes in the MT group varied slightly but did not affect triage between groups.

  • stroke
  • CT perfusion

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  • Contributors Guarantor of integrity of the entire study: GB, CD, EK, SOG, BP, ES. Study concepts and design: GB, CD, SOG. Literature research: GB, EK, CBZ, SA. Clinical studies: NA. Experimental studies/data analysis: GB, EK, MJ, CBZ, SA, CEW. Statistical analysis: EK, MJ, GB, CEW. Manuscript preparation: GB, SOG, CD, ES. Manuscript editing: GB, CD, EK, BP, SOG, ES.

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval Study was performed post institutional ethical/IRB approval (IRB# 201809766). Informed consent was waived, given the retrospective nature of the study.

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

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