A Korean retrospective study evaluated AI tools, Rapid CTP (RapidAI) and JLK-CTP (JLK inc.), for estimating ischemic core and hypoperfused tissue volumes using CT perfusion (CTP) scans of 327 ischemic stroke patients presenting within 24 h of onset. The study aimed to compare the accuracy and agreement between the two automated CT perfusion software packages. JLK-CTP and RAPID CTP showed excellent intersoftware agreement in estimating ischemic core volumes (ρ = 0.958) and substantial intersoftware agreement for hypoperfused tissue volumes (ρ = 0.855). The early follow-up infarct volume showed substantial agreement for both packages compared to diffusion-weighted images (JLK-CTP, ρ = 0.751; RAPID, ρ = 0.632), but was generally overestimated by both AI tools.
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Comparison of two automated CT perfusion software packages in patients with ischemic stroke presenting within 24 h of onset
Frontiers in Neuroscience, 2024
Abstract
Background:
We compared the ischemic core and hypoperfused tissue volumes estimated by RAPID and JLK-CTP, a newly developed automated computed tomography perfusion (CTP) analysis package. We also assessed agreement between ischemic core volumes by two software packages against early follow-up infarct volumes on diffusion-weighted images (DWI).
Methods:
This retrospective study analyzed 327 patients admitted to a single stroke center in Korea from January 2021 to May 2023, who underwent CTP scans within 24 h of onset. The concordance correlation coefficient (ρ) and Bland–Altman plots were utilized to compare the volumes of ischemic core and hypoperfused tissue volumes between the software packages. Agreement with early (within 3 h from CTP) follow-up infarct volumes on diffusion-weighted imaging (n = 217) was also evaluated.
Results:
The mean age was 70.7 ± 13.0 and 137 (41.9%) were female. Ischemic core volumes by JLK-CTP and RAPID at the threshold of relative cerebral blood flow (rCBF) < 30% showed excellent agreement (ρ = 0.958 [95% CI, 0.949 to 0.966]). Excellent agreement was also observed for time to a maximum of the residue function (Tmax) > 6 s between JLK-CTP and RAPID (ρ = 0.835 [95% CI, 0.806 to 0.863]). Although early follow-up infarct volume showed substantial agreement in both packages (JLK-CTP, ρ = 0.751 and RAPID, ρ = 0.632), ischemic core volumes at the threshold of rCBF <30% tended to overestimate ischemic core volumes.
Conclusion:
JLK-CTP and RAPID demonstrated remarkable concordance in estimating the volumes of the ischemic core and hypoperfused area based on CTP within 24 h from onset.