Enhancing performance of a computed tomography perfusion software for improved prediction of final infarct volume in acute ischemic stroke patients

Computed tomography perfusion (CTP) is crucial for acute ischemic stroke (AIS) patient diagnosis. To improve infarct prediction, enhanced image processing and automated parameter selection have been implemented in Vital Images' new CTP + software. We compared CTP + with its previous version, commercially available software (RAPID and Sphere), and follow-up diffusion-weighted imaging (DWI). Data from 191 AIS patients between March 2019 and January 2020 was retrospectively collected and allocated into endovascular intervention (n = 81) and conservative treatment (n=110) cohorts. Intervention patients were treated for large vessel occlusion, underwent mechanical thrombectomy, and achieved successful reperfusion of thrombolysis in cerebral infarction 2b/2c/3. Conservative treatment patients suffered large or small vessel occlusion and did not receive intravenous thrombolysis or mechanical thrombectomy. Infarct and penumbra were assessed using intervention and conservative treatment patients, respectively. Infarct and penumbra volumes were segmented from CTP+ and compared with 24-h DWI along with RAPID, Sphere, and Vitrea. Mean infarct differences (95% confidence intervals) and Spearman correlation coefficients (SCCs) between DWI and each CTP software product for intervention patients are: CTP+ = (5.8 +/- 5.9 ml, 0.62), RAPID = (10.0 +/- 5.2 ml, 0.73), Sphere = (3.0 +/- 6.0 ml, 0.56), Vitrea = (7.2 +/- 4.9 ml, 0.66). For conservative treatment patients, mean infarct differences and SCCs are: CTP+ (-8.0 +/- 5.4 ml, 0.64), RAPID = (-25.6 +/- 11.5 ml, 0.60), Sphere = (-25.6 +/- 8.0 ml, 0.66), Vitrea = (1.3 +/- 4.0 ml, 0.72). CTP+ performed similarly to RAPID and Sphere in addition to its semi-automated predecessor, Vitrea, when assessing intervention patient infarct volumes. For conservative treatment patients, CTP+ outperformed RAPID and Sphere in assessing penumbra. Semi-automated Vitrea remains the most accurate in assessing penumbra, but CTP+ provides an improved workflow from its predecessor.