Automated assessment of ischemic core on noncontrast computed tomography: a multicenter comparative analysis with CT perfusion

Objective: To assess the performance of the Brainomix 360 software (Brainomix) in evaluating ischemic core volumes on NCCT compared with CT perfusion (CTP) in patients with acute ischemic stroke.

Methods: This retrospective multicenter study included patients with anterior circulation large vessel occlusions who underwent pretreatment NCCT and CTP, successful reperfusion (mTICI ≥2b), and post-treatment MRI from three stroke centers. Ischemic core volumes were calculated on NCCT using the ML algorithm deployed by Brainomix 360 and on CTP using Olea software, with comparison to MRI-derived final infarct volume (FIV).

Results: A total of 111 patients were included. Estimated ischemic core volumes were 20.4 ± 19.0 mL on NCCT and 19.9 ± 18.6 mL on CTP, with no significant difference (P = 0.82). A moderate but significant correlation was found between NCCT and CTP core estimates (r = 0.40, P < 0.001). Correlations between FIV and core estimates were similar for NCCT (r = 0.30) and CTP (r = 0.36).

Conclusions: Machine learning-based ischemic core volume estimates on NCCT using Brainomix 360 are comparable in magnitude and correlation to those obtained from concurrent CTP and MR-assessed FIV.