Comparison of a Bayesian estimation algorithm and singular value decomposition algorithms for 80-detector row CT perfusion in patients with acute ischemic stroke

Purpose A variety of postprocessing algorithms for CT perfusion are available, with substantial differences in terms of quantitative maps. Although potential advantages of a Bayesian estimation algorithm are suggested, direct comparison with other algorithms in clinical settings remains scarce. We aimed to compare performance of a Bayesian estimation algorithm and singular value decomposition (SVD) algorithms for the assessment of acute ischemic stroke using an 80-detector row CT perfusion. Methods CT perfusion data of 36 patients with acute ischemic stroke were analyzed using the Vitrea implemented a standard SVD algorithm, a reformulated SVD algorithm and a Bayesian estimation algorithm. Correlations and statistical differences between affected and contralateral sides of quantitative parameters (cerebral blood volume [CBV], cerebral blood flow [CBF], mean transit time [MTT], time to peak [TTP] and delay) were analyzed. Agreement of the CT perfusion-estimated and the follow-up diffusion-weighted imaging-derived infarct volume were evaluated by nonparametric Passing-Bablok regression analysis. Results CBF and MTT of the Bayesian estimation algorithm were substantially different and showed a better correlation with the standard SVD algorithm (rho = 0.78 and 0.80, p < 0.001) than with the reformulated SVD algorithm (rho = 0.59 and 0.39, p < 0.001). There is no significant difference in MTT only when using the reformulated SVD algorithm (p = 0.217). Regarding the regression lines, the slope and intercept were nearly ideal with the Bayesian estimation algorithm (y = 2.42 x-6.51; rho = 0.60, p < 0.001) in comparison with the SVD algorithms. Conclusions The Bayesian estimation algorithm can lead to a better performance compared with the SVD algorithms in the assessment of acute ischemic stroke because of better delineation of abnormal perfusion areas and accurate estimation of infarct volume.