Assessment of a Bayesian Vitrea CT Perfusion Analysis to Predict Final Infarct and Penumbra Volumes in Patients with Acute Ischemic Stroke: A Comparison with RAPID

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Data were retrospectively collected for 105 patients with acute ischemic stroke (55 patients with successful recanalization [TICI 2b/2c/3] and large-vessel occlusions and 50 patients without interventions). Final infarct volumes were calculated using DWI and FLAIR 24 hours following CTP imaging. RAPID and the Vitrea Bayesian CTP algorithm (with 3 different settings) predicted infarct and penumbra volumes for comparison with final infarct volumes to assess software performance. RAPID and Vitrea default setting had the most accurate final infarct volume prediction in patients with interventions. Default Vitrea and RAPID were the most and least accurate in determining final infarct volume for patients without an intervention, respectively. Compared with RAPID, the Vitrea default setting was noninferior for patients with interventions and superior in penumbra estimation for patients without interventions as indicated by mean infarct differences and correlations with final infarct volumes.

Abstract

BACKGROUND AND PURPOSE

Figure 1 from Rava et al
Ground truth infarct labels with the hyperintensified regions in the DWI and FLAIR identifying infarct. Default, CBV, and CBF Vitrea perfusion analysis demonstrates infarct as red and penumbra as yellow, while RAPID perfusion analysis represents infarct as pink and penumbra as green. For this nonintervention case, there is agreement between Vitrea and RAPID infarct volumes and their respective locations within the MR imaging scans. Final infarct volumes for each MR imaging method and CTP software (summation of infarct and penumbra due to it being a nonintervention case) are as follows: DWI = 135.0 mL, FLAIR = 167.6 mL, default Vitrea = 132.4 mL, CBV Vitrea = 141.2 mL, CBF Vitrea = 115.3 mL, RAPID = 176.0 mL.

Brain CTP is used to estimate infarct and penumbra volumes to determine endovascular treatment eligibility for patients with acute ischemic stroke. We aimed to assess the accuracy of a Bayesian CTP algorithm in determining penumbra and final infarct volumes.

MATERIALS AND METHODS

Data were retrospectively collected for 105 patients with acute ischemic stroke (55 patients with successful recanalization [TICI 2b/2c/3] and large-vessel occlusions and 50 patients without interventions). Final infarct volumes were calculated using DWI and FLAIR 24 hours following CTP imaging. RAPID and the Vitrea Bayesian CTP algorithm (with 3 different settings) predicted infarct and penumbra volumes for comparison with final infarct volumes to assess software performance. Vitrea settings used different combinations of perfusion maps (MTT, TTP, CBV, CBF, delay time) for infarct and penumbra quantification. Patients with and without interventions were included for assessment of predicted infarct and penumbra volumes, respectively.

RESULTS

RAPID and Vitrea default setting had the most accurate final infarct volume prediction in patients with interventions ([Spearman correlation coefficient, mean infarct difference] default versus FLAIR: [0.77, 4.1 mL], default versus DWI: [0.72, 4.7 mL], RAPID versus FLAIR: [0.75, 7.5 mL], RAPID versus DWI: [0.75, 6.9 mL]). Default Vitrea and RAPID were the most and least accurate in determining final infarct volume for patients without an intervention, respectively (default versus FLAIR: [0.76, –0.4 mL], default versus DWI: [0.71, –2.6 mL], RAPID versus FLAIR: [0.68, −49.3 mL], RAPID versus DWI: [0.65, –51.5 mL]).

CONCLUSIONS

Compared with RAPID, the Vitrea default setting was noninferior for patients with interventions and superior in penumbra estimation for patients without interventions as indicated by mean infarct differences and correlations with final infarct volumes.

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Assessment of a Bayesian Vitrea CT Perfusion Analysis to Predict Final Infarct and Penumbra Volumes in Patients with Acute Ischemic Stroke: A Comparison with RAPID
Jeffrey Ross
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