Lincbiotech SL, Parque Tecnológico de Galicia, Ourense, Spain.
Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute, (IDIBGI), Dr Josep Trueta University Hospital, Girona, Spain.
J Xray Sci Technol. 2021;29(5):823-834. doi: 10.3233/XST-210898.
Estimates of parameters used to select patients for endovascular thrombectomy (EVT) for acute ischemic stroke differ among software packages for automated computed tomography (CT) perfusion analysis. To determine impact of these differences in decision making, we analyzed intra-observer and inter-observer agreement in recommendations about whether to perform EVT based on perfusion maps from 4 packages.
Perfusion CT datasets from 63 consecutive patients with suspected acute ischemic stroke were retrospectively postprocessed with 4 packages of Minerva, RAPID, Olea, and IntelliSpace Portal (ISP). We used Pearson correlation coefficients and Bland-Altman analysis to compare volumes of infarct core, penumbra, and mismatch calculated by Minerva and RAPID. We used kappa analysis to assess agreement among decisions of 3 radiologists about whether to recommend EVT based on maps generated by 4 packages.
We found significant differences between using Minerva and RAPID to estimate penumbra (67.39±41.37mL vs. 78.35±45.38 mL, p < 0.001) and mismatch (48.41±32.03 vs. 61.27±32.73mL, p < 0.001), but not of infarct core (p = 0.230). Pearson correlation coefficients were 0.94 (95%CI:0.90-0.96) for infarct core, 0.87 (95%CI:0.79-0.91) for penumbra, and 0.72 (95%CI:0.57-0.83) for mismatch volumes (p < 0.001). Limits of agreements were (-21.22-25.02) for infarct core volumes, (-54.79-32.88) for penumbra volumes, and (-60.16-34.45) for mismatch volumes. Final agreement for EVT decision-making was substantial between Minerva vs. RAPID (k = 0.722), Minerva vs. Olea (k = 0.761), and RAPID vs. Olea (k = 0.782), but moderate for ISP vs. the other three.
Despite quantitative differences in estimates of infarct core, penumbra, and mismatch using 4 software packages, their impact on radiologists' decisions about EVT is relatively small.
用于选择急性缺血性脑卒中血管内血栓切除术（EVT）患者的参数估计值因自动化 CT 灌注分析软件包而异。为了确定这些决策中的差异的影响，我们分析了基于 4 种软件包的灌注图得出的关于是否进行 EVT 的建议的观察者内和观察者间一致性。
回顾性地对 63 例疑似急性缺血性脑卒中患者的灌注 CT 数据集进行了 Minerva、RAPID、Olea 和 IntelliSpace Portal（ISP）4 种软件包的后处理。我们使用 Pearson 相关系数和 Bland-Altman 分析比较了 Minerva 和 RAPID 计算的梗死核心、半暗带和不匹配体积。我们使用 Kappa 分析评估了 3 名放射科医生根据 4 种软件包生成的图谱做出的 EVT 推荐决策的一致性。
我们发现使用 Minerva 和 RAPID 估计半暗带（67.39±41.37mL vs. 78.35±45.38mL，p<0.001）和不匹配（48.41±32.03 vs. 61.27±32.73mL，p<0.001）有显著差异，但梗死核心无显著差异（p=0.230）。梗死核心的 Pearson 相关系数为 0.94（95%CI：0.90-0.96），半暗带为 0.87（95%CI：0.79-0.91），不匹配为 0.72（95%CI：0.57-0.83）（p<0.001）。梗死核心体积的一致性界限为（-21.22-25.02），半暗带体积为（-54.79-32.88），不匹配体积为（-60.16-34.45）。Minerva 与 RAPID（k=0.722）、Minerva 与 Olea（k=0.761）、RAPID 与 Olea（k=0.782）之间的 EVT 决策最终一致性较大，但 ISP 与其他三种软件之间的一致性为中度。
尽管 4 种软件包对梗死核心、半暗带和不匹配的估计存在定量差异，但它们对放射科医生关于 EVT 的决策的影响相对较小。
