Comparison of CT Perfusion Software Packages for Thrombectomy Eligibility

Introduction: Computed tomography perfusion (CTP) has played an important role in patient selection for mechanical thrombectomy (MT) in acute ischemic stroke. We aimed to investigate the agreement between perfusion parametric maps of 3 software packages – RAPID (RapidAI-IschemaView), Viz CTP (Viz.ai), and e-CTP (Brainomix) – in estimating baseline ischemic core volumes of near completely/completely reperfused patients.

Methods: We retrospectively reviewed a prospectively maintained MT database to identify patients with anterior circulation large vessel occlusion strokes involving the ICA or MCA M1-segment treated during September 2018 to November 2019. A subset with near-complete/complete reperfusion (eTICI 2c–3) was used to compare pre-procedural prediction of final infarct volumes.

Results: In this analysis of 242 patients, RAPID and Viz CTP rCBF<30% values had substantial agreement (ρ = 0.767), as did RAPID and e-CTP (ρ = 0.668). Tmax>6s agreement was excellent between RAPID and Viz CTP (ρ = 0.811) and substantial for RAPID and e-CTP (ρ = 0.749). Final infarct volume prediction was substantial in all 3 packages (RAPID ρ = 0.744; Viz CTP ρ = 0.711; e-CTP ρ = 0.600).

Conclusion: Perfusion parametric maps of the RAPID, Viz CTP, and e-CTP software have substantial agreement in predicting final infarct volume in near-completely/completely reperfused patients.