Abstract
ObjectiveTo compare two established software applications in terms of apparent diffusion coefficient (ADC) lesion volumes, volume of critically hypoperfused brain tissue, and calculated volumes of perfusion-diffusion mismatch in brain MRI of patients with acute ischemic stroke.MethodsBrain MRI examinations of 81 patients with acute stroke due to large vessel occlusion of the anterior circulation were analyzed. The volume of hypoperfused brain tissue, ADC volume, and the volume of perfusion-diffusion mismatch were calculated automatically with two different software packages. The calculated parameters were compared quantitatively using formal statistics.ResultsSignificant difference was found for the volume of hypoperfused tissue (median 91.0 ml vs. 102.2 ml; p < 0.05) and the ADC volume (median 30.0 ml vs. 23.9 ml; p < 0.05) between different software packages. The volume of the perfusion-diffusion mismatch differed significantly (median 47.0 ml vs. 67.2 ml; p < 0.05). Evaluation of the results on a single-subject basis revealed a mean absolute difference of 20.5 ml for hypoperfused tissue, 10.8 ml for ADC volumes, and 27.6 ml for mismatch volumes, respectively. Application of the DEFUSE 3 threshold of 70 ml infarction core would have resulted in dissenting treatment decisions in 6/81 (7.4%) patients.ConclusionVolume segmentation in different software products may lead to significantly different results in the individual patient and may thus seriously influence the decision for or against mechanical thrombectomy.Key Points• Automated calculation of MRI perfusion-diffusion mismatch helps clinicians to apply inclusion and exclusion criteria derived from randomized trials.• Infarct volume segmentation plays a crucial role and lead to significantly different result for different computer programs.• Perfusion-diffusion mismatch estimation from different computer programs may influence the decision for or against mechanical thrombectomy.
Highlights
Significant difference was found for the volume of hypoperfused tissue and the apparent diffusion coefficient (ADC) volume between different software packages
Volume segmentation in different software products may lead to significantly different results in the individual patient and may seriously influence the decision for or against mechanical thrombectomy
Mechanical thrombectomy (MT) performed within 6 h from symptom onset is regarded as gold standard therapy in patients with acute ischemic stroke caused by large vessel occlusion (LVO) in the anterior circulation [1,2,3,4,5,6,7,8,9]
Summary
Mechanical thrombectomy (MT) performed within 6 h from symptom onset is regarded as gold standard therapy in patients with acute ischemic stroke caused by large vessel occlusion (LVO) in the anterior circulation [1,2,3,4,5,6,7,8,9]. The evaluation of the presumable infarct core volume by means of MR diffusion-weighted imaging (DWI) and the volume of putatively critically hypoperfused brain tissue by means of MR perfusion imaging (PWI) could provide crucial information about potentially salvageable ischemic brain tissue that could be functionally recovered, if perfusion is restored sufficiently. The difference between both volumes (i.e., the assumed penumbra) usually referred to as perfusion-diffusion mismatch represents an approximate measure of the tissue at risk and has been investigated in detail over the last two decades [13, 14]. Quantification of the infarct core (with or without perfusion-diffusion mismatch) has been regarded as mandatory by AHA/ASO recommendations in the process of decision-making for MT to select those patients that will most likely benefit from such treatment [12, 17]
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