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Original research
Assessment of three MR perfusion software packages in predicting final infarct volume after mechanical thrombectomy
  1. Alexandre Bani-Sadr1,2,
  2. Tae-Hee Cho3,
  3. Matteo Cappucci1,
  4. Marc Hermier1,
  5. Roxana Ameli1,
  6. Andrea Filip1,
  7. Roberto Riva1,
  8. Laurent Derex3,
  9. Charles De Bourguignon4,
  10. Laura Mechtouff3,
  11. Omer F Eker1,2,
  12. Norbert Nighoghossian3,
  13. Yves Berthezene1,2
  1. 1Neuroradiology, Hospices Civils de Lyon, Bron, France
  2. 2MYRIAD, CREATIS, Villeurbanne, France
  3. 3Stroke Department, Hospices Civils de Lyon, Lyon, France
  4. 4Centre d'Investigations Cliniques, Hospices Civils de Lyon, Lyon, France
  1. Correspondence to Dr Alexandre Bani-Sadr, Neuroradiology, Hospices Civils de Lyon, Bron, France; apbanisadr{at}


Aims To evaluate the performance of three MR perfusion software packages (A: RAPID; B: OleaSphere; and C: Philips) in predicting final infarct volume (FIV).

Methods This cohort study included patients treated with mechanical thrombectomy following an admission MRI and undergoing a follow-up MRI. Admission MRIs were post-processed by three packages to quantify ischemic core and perfusion deficit volume (PDV). Automatic package outputs (uncorrected volumes) were collected and corrected by an expert. Successful revascularization was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2B. Uncorrected and corrected volumes were compared between each package and with FIV according to mTICI score.

Results Ninety-four patients were included, of whom 67 (71.28%) had a mTICI score ≥2B. In patients with successful revascularization, ischemic core volumes did not differ significantly from FIV regardless of the package used for uncorrected and corrected volumes (p>0.15). Conversely, assessment of PDV showed significant differences for uncorrected volumes. In patients with unsuccessful revascularization, the uncorrected PDV of packages A (median absolute difference −40.9 mL) and B (median absolute difference −67.0 mL) overestimated FIV to a lesser degree than package C (median absolute difference −118.7 mL; p=0.03 and p=0.12, respectively). After correction, PDV did not differ significantly from FIV for all three packages (p≥0.99).

Conclusions Automated MRI perfusion software packages estimate FIV with high variability in measurement despite using the same dataset. This highlights the need for routine expert evaluation and correction of automated package output data for appropriate patient management.

  • MR perfusion
  • Stroke
  • Thrombectomy

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request from the corresponding author.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request from the corresponding author.

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  • Contributors ABS, THC, NN and YB conceived and designed the project. YB and NN supervised the project. ABS, LM and OFE performed the measurements. THC, MC, MH, RA, AF, RR, LD, CDB, LM and OFE made substantial contributions to acquisition of data. ABS, LM, LD, NN and YB drafted the article and revised it critically and is the guarantor of the study. YB is the guarantor of this study. All authors approved the version to be published.

  • Funding This study was supported by the RHU MARVELOUS (Recherche Hospitalo- Universitaire MR Imaging to Prevent Cerebral and Myocardial Injury, ANR-16-RHUS- 0009) of Claude Bernard University, Lyon I within the program “Investissements d’Avenir” operated by the French National Research Agency (ANR).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.