Automated MRI perfusion-diffusion mismatch estimation may be significantly different in individual patients when using d
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NEURO
Automated MRI perfusion-diffusion mismatch estimation may be significantly different in individual patients when using different software packages Hannes Deutschmann 1 & Nicole Hinteregger 1 & Ulrike Wießpeiner 1 & Markus Kneihsl 2 & Simon Fandler-Höfler 2 & Manuela Michenthaler 1 & Christian Enzinger 1,2 & Eva Hassler 1 & Stefan Leber 1 & Gernot Reishofer 1 Received: 12 February 2020 / Revised: 22 June 2020 / Accepted: 5 August 2020 # The Author(s) 2020
Abstract Objective To compare two established software applications in terms of apparent diffusion coefficient (ADC) lesion volumes, volume of critically hypoperfused brain tissue, and calculated volumes of perfusion-diffusion mismatch in brain MRI of patients with acute ischemic stroke. Methods Brain MRI examinations of 81 patients with acute stroke due to large vessel occlusion of the anterior circulation were analyzed. The volume of hypoperfused brain tissue, ADC volume, and the volume of perfusion-diffusion mismatch were calculated automatically with two different software packages. The calculated parameters were compared quantitatively using formal statistics. Results Significant difference was found for the volume of hypoperfused tissue (median 91.0 ml vs. 102.2 ml; p < 0.05) and the ADC volume (median 30.0 ml vs. 23.9 ml; p < 0.05) between different software packages. The volume of the perfusion-diffusion mismatch differed significantly (median 47.0 ml vs. 67.2 ml; p < 0.05). Evaluation of the results on a single-subject basis revealed a mean absolute difference of 20.5 ml for hypoperfused tissue, 10.8 ml for ADC volumes, and 27.6 ml for mismatch volumes, respectively. Application of the DEFUSE 3 threshold of 70 ml infarction core would have resulted in dissenting treatment decisions in 6/81 (7.4%) patients. Conclusion Volume segmentation in different software products may lead to significantly different results in the individual patient and may thus seriously influence the decision for or against mechanical thrombectomy. Key Points • Automated calculation of MRI perfusion-diffusion mismatch helps clinicians to apply inclusion and exclusion criteria derived from randomized trials. • Infarct volume segmentation plays a crucial role and lead to significantly different result for different computer programs. • Perfusion-diffusion mismatch estimation from different computer programs may influence the decision for or against mechanical thrombectomy. Keywords Brain . Thrombectomy . Stroke . Magnetic resonance imaging . Software
Abbreviations LVO Large vessel occlusion MT Mechanical thrombectomy
* Gernot Reishofer [email protected] 1
Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036 Graz, Austria
2
Department of Neurology, Division of General Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
Introduction Mechanical thrombectomy (MT) performed within 6 h from symptom onset is regarded as gold standard therapy in patie
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