Comparison of two automated CT perfusion software packages in patients with ischemic stroke presenting within 24 h of onset

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Comparison of two automated CT perfusion software packages in patients with ischemic stroke presenting within 24 h of onset

Nak-Hoon Kim¹Sue Young Ha²Gi-Hun Park²Jong-Hyeok Park²Dongmin Kim²Leonard Sunwoo³Min-Surk Kye⁴Sung Hyun Baik³Cheolkyu Jung³Wi-Sun Ryu^2*Beom Joon Kim^1*

• ¹Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
• ²Artificial Intelligence Research Center, JLK Inc., Seoul, Republic of Korea
• ³Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
• ⁴Department of Neurology, Seongnam Citizens Medical Center, Seongnam, Republic of Korea

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 (T_max) > 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.