Evaluation of Diffusion–Perfusion Mismatch in Acute Ischemic Stroke with a New Automated Perfusion-Weighted Imaging Software: A Retrospective Study

Abstract

Introduction The aim of this study was to evaluate the accuracy of automated software (iStroke) on magnetic resonance (MR) apparent diffusion coefficient (ADC) and perfusion-weighted imaging (PWI) against ground truth in assessing infarct core, and compare the hypoperfusion volume and mismatch volume on iStroke with those on Food and Drug Administration-approved software (RAPID) in patients with acute ischemic stroke. Methods We used the single-volume decomposition method to develop the iStroke (iStroke; Beijing Tiantan Hospital, Beijing, China) software. Patients with ischemic stroke were collected from two educational hospitals in China with MR-PWI performed in the emergency department within 24 h of symptom onset. Infarct core volume was defined as ADC < 620 × 10 −6 mm 2 /s and hypoperfusion volume was defined as Tmax > 6 s. We compared the accuracy of infarct core volume using iStroke and RAPID (iSchema View Inc, Menlo Park, CA) software with ground truth. Results We included 405 patients with acute ischemic stroke with MR ADC and PWI sequences. The infarct core volume on iStroke (median 2.43 ml, interquartile range [IQR] 0.60–10.32 ml) was not significantly different from the ground truth (median 2.89 ml, IQR 0.77–9.17 ml) ( P = 0.07); Bland–Altman curves showed that the core volume of iStroke and RAPID software were comparable with each other on individual agreement with ground truth. The hypoperfusion volume and mismatch volume on iStroke were not statistically different from those on the RAPID software, respectively. In patients with large vessel occlusion ( n = 74), the agreement between iStroke and RAPID was substantial (kappa = 0.76) according to DEFUSE 3 criteria (infarct core < 70 ml, mismatch volume ≥ 15 ml, and mismatch ratio ≥ 1.8). Conclusions The iStroke automatic processing of ADC and PWI is a reliable software for the identification of diffusion–perfusion mismatch in acute ischemic stroke.

Rationale and design of Treatment of Acute Ischaemic Stroke with Edaravone Dexborneol II (TASTE-2): a multicentre randomised controlled trial

“…ZL202110266924.6 and ZL202110226735.6) has been described elsewhere. 22 Patients will be excluded if CT scan indicating intracranial haemorrhagic diseases, being given any IVTs other than alteplase before EVT, being allergic to any components of edaravone dexborneol injection, having a history of congenital or acquired haemorrhagic disease, with an elevated systolic blood pressure surpassing 180 mm Hg or diastolic blood pressure exceeding 110 mm Hg after therapy, being in cases where the serum levels of alanine aminotransferase or aspartate transaminase are found to exceed three times the upper limit of normal, or if the current serum creatinine exceeds 1.5 times the upper limit of normal, or if the estimated glomerular Open access filtration rate falls below 60 mL/min, etc (figure 2). Patients who have recently been administered or are currently receiving any Chinese traditional medicine containing borneol should also be excluded.…”

Assessment of Perfusion Volumes by a New Automated Software for Computed Tomography Perfusion

“…In a previous study, we demonstrated that the automated software iStroke (Beijing Tiantan Hospital and Biomind, Beijing, China) predicted perfusion parameters on magnetic resonance perfusion-weighted imaging. 15 However, whether iStroke has similar accuracy by measuring perfusion volumes on CTP using deep neural networks to the RAPID software and its predictive ability for clinical functional outcomes are unclear. Therefore, we sought to compare the agreement of iStroke and RAPID on CTP imaging with ground truth on DWI and the association of infarct core volume (ICV) by softwares with clinical functional outcomes in patients with AIS who underwent endovascular treatment (EVT) with complete recanalisation.…”