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109 Pair-wise differences of penumbra and core volume estimates from three computed tomography perfusion software packages are influenced by site of large vessel occlusion
  1. Peter SW Park1,2,
  2. Robbie Chan1,
  3. Channa Senanayake1,
  4. Stanley MK Tsui1,
  5. Alun Pope2,
  6. Helen M Dewey1,2 and
  7. Philip MC Choi1,2
  1. 1Department of Neurosciences, Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia
  2. 2Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Box Hill, VIC, Australia


Objectives Computed tomography perfusion (CTP) data are important for hyperacute stroke decision making. Comparisons between outputs of different CTP software packages are limited. We aimed to assess the pair-wise differences in infarct and penumbra estimates produced by three CTP software packages – MIStar, RAPID, and Vitrea.

Methods Consecutive patients with suspected acute ischaemic stroke who underwent CTP between July 2020 and June 2021 at our hospital were independently reviewed by two expert readers. Pair-wise differences between software estimates of penumbra and core volumes were calculated for each patient, with analysis stratified by large vessel occlusion (LVO) status (no-LVO, proximal M2, M1 and internal carotid artery-T [ICA-T]).

Results 580 CTP studies were performed; 262 were normal, 146 technically poor, with 172 included in the final analysis. 79/172 (45.9%) had LVO; proximal M2 (n=21), M1 (n=38) and ICA-T (n=20). Overall, statistically significant pair-wise differences were seen for both penumbra and core estimates (P <0.001). The largest difference in mean core estimates were seen between Vitrea and MIStar ([mean, 95% confidence interval] no-LVO [5.8ml, 3.2–8.4]; proximal M2 [10.4ml, 3.9–17.0]; M1 [17.7ml, 8.9–26.6]; ICA-T [38.9ml, 20.2–57.7]). More comparable penumbra estimates were observed between RAPID and MIStar (no-LVO [1.79ml, -3.9–7.51]; proximal M2 [13.1ml, -0.24–26.5]; M1 [10.7ml, -5.9–27.3]; ICA-T [28.4ml, 0.78–56.0]).

Conclusion Core and penumbra volume estimates vary significantly between CTP software packages. There are minimal differences in patients with non-LVO stroke, with the greatest differences seen in patients with ICA-T occlusions.

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