PT  - JOURNAL ARTICLE
AU  - Miou S Koopman
AU  - Olvert A Berkhemer
AU  - Ralph R E G Geuskens
AU  - Bart J Emmer
AU  - Marianne A A van Walderveen
AU  - Sjoerd F M Jenniskens
AU  - Wim H van Zwam
AU  - Robert J van Oostenbrugge
AU  - Aad van der Lugt
AU  - Diederik W J Dippel
AU  - Ludo F Beenen
AU  - Yvo B W E M Roos
AU  - Henk A Marquering
AU  - Charles B L M Majoie
ED  - ,
TI  - Comparison of three commonly used CT perfusion software packages in patients with acute ischemic stroke
AID  - 10.1136/neurintsurg-2019-014822
DP  - 2019 Dec 01
TA  - Journal of NeuroInterventional Surgery
PG  - 1249--1256
VI  - 11
IP  - 12
4099  - http://jnis.bmj.com/content/11/12/1249.short
4100  - http://jnis.bmj.com/content/11/12/1249.full
SO  - J NeuroIntervent Surg2019 Dec 01; 11
AB  - Background and purpose CT perfusion (CTP) might support decision making in patients with acute ischemic stroke by providing perfusion maps of ischemic tissue. Currently, the reliability of CTP is hampered by varying results between different post-processing software packages. The purpose of this study is to compare ischemic core volumes estimated by IntelliSpace Portal (ISP) and syngo.via with core volumes as estimated by RAPID.Methods Thirty-five CTP datasets from patients in the MR CLEAN trial were post-processed. Core volumes were estimated with ISP using default settings and with syngo.via using three different settings: default settings (method A); additional smoothing filter (method B); and adjusted settings (method C). The results were compared with RAPID. Agreement between methods was assessed using Bland–Altman analysis and intraclass correlation coefficient (ICC). Accuracy for detecting volumes up to 25 mL, 50 mL, and 70 mL was assessed. Final infarct volumes were determined on follow-up non-contrast CT.Results Median core volume was 50 mL with ISP, 41 mL with syngo.via method A, 20 mL with method B, 36 mL with method C, and 11 mL with RAPID. Agreement ranged from poor (ISP: ICC 0.41; method A: ICC 0.23) to good (method B: ICC 0.83; method C: ICC 0.85). The bias (1.8 mL) and limits of agreement (−27, 31 mL) were the smallest with syngo.via with additional smoothing (method B). Agreement for detecting core volumes ≤25 mL with ISP was 54% and 57%, 85% and 74% for syngo.via methods A, B, and C, respectively.Conclusion Best agreement with RAPID software is provided by syngo.via default settings with additional smoothing. Moreover, this method has the highest agreement in categorizing patients with small core volumes.