Comparison of two automated CT perfusion software packages in patients with ischemic stroke presenting within 24 hours of onset

ABSTRACT Background We compared the ischemic core and hypoperfused tissue volumes estimated by RAPID and JBS-10K, a newly developed automated CT perfusion (CTP) analysis package. We also assessed agreement between ischemic core volumes by two software packages against early follow-up infarct volumes on diffusion-weighted images (DWI). Methods This retrospective study analyzed 327 patients admitted to a single stroke center in Korea from January 2021 to May 2023, who underwent CTP scans within 24 hours of onset. The concordance correlation coefficient and Bland-Altman plots were utilized to compare the volumes of ischemic core and hypoperfused tissue volumes between the software packages. Agreement with early (within 3 hours from CTP) follow-up infarct volumes on diffusion-weighted imaging (n=217) was also evaluated. Results The mean age was 70.7±13.0 and 137 (41.9%) were female. Ischemic core volumes by JBS-10K and RAPID in the threshold of relative cerebral blood flow (rCBF) 6 seconds between JBS-10K and RAPID (ρ = 0.835 [95% CI, 0.806 to 0.863]). Although early follow-up infarct volume showed substantial agreement in both packages (JBS-10K ρ = 0.751 and RAPID ρ = 0.632), ischemic core volumes at the threshold of rCBF <30% tended to overestimate ischemic core volumes. Conclusion JBS-10K and RAPID demonstrated remarkable concordance in estimating the volumes of the ischemic core and hypoperfused area based on CTP within 24 hours from onset.