Post-processing of computed tomography perfusion in patients with acute cerebral ischemia: variability of inter-reader,
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COMPUTED TOMOGRAPHY
Post-processing of computed tomography perfusion in patients with acute cerebral ischemia: variability of inter-reader, inter-region of interest, inter-input model, and inter-software Zhong-Ping Chen 1 & Zhen-Zhen Shi 1 & Yun-Geng Li 1 & Yan Guo 2 & Dan Tong 1 Received: 31 August 2019 / Revised: 3 April 2020 / Accepted: 3 June 2020 # European Society of Radiology 2020
Abstract Objective To determine the reproducibility of quantitative computed tomography perfusion (CTP) parameters generated using different post-processing methods and identify the relative impact of subjective factors on the robustness of CTP parameters in acute ischemic stroke (AIS). Materials and methods A total of 80 CTP datasets from patients with AIS or transient ischemic attack (TIA) were retrospectively post-processed by two observers using different regions of interest (ROI) types, input models, and software. The CTP parameters were derived for 10 parenchymal ROIs. The intra-class correlation coefficients (ICCs) were used to assess the reproducibility of the CTP parameters for various post-processing methods. The Spearman correlation test was used to detect potential relationships between software and input models. Results The ICCs with 95% confidence intervals (CIs) were 0.94 (0.93–0.96), 0.94 (0.92–0.96), 0.82 (0.79–0.86), and 0.87 (0.85–0.90) for inter-reader agreement by using elliptic ROI, irregular ROI, single-input model, and dual-input model, respectively. The ICCs with 95% CI were 0.98 (0.98–0.98), 0.46 (0.43–0.50), and 0.25 (0.20–0.30) for inter-ROI type, inter-input model, and inter-software agreement, respectively. Conclusions Although the CTP parameters were stable when measured using different readers with different ROI types, they varied for different input models and software. The standardization of CTP post-processing is essential to reduce variability of CTP values. Key Points • The CTP parameters derived by different readers with different ROI types have agreements that range from good to excellent. • The CTP parameters derived from different input models and software programs have poor agreement but significant correlations. Keywords Tomography X-ray computed . Perfusion . Reproducibility of results . Brain ischemia
Abbreviations AIF Arterial input function
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07000-7) contains supplementary material, which is available to authorized users. * Dan Tong [email protected] 1
Department of Radiology, The First Hospital of Jilin University, Changchun 130021, Jilin, China
2
Life Sciences, GE Healthcare, Shenyang 110000, China
AIS CBF CBV CTP CTT ICC MCA MTT ROI SVD TIA TTP VOF
Acute ischemic stroke Cerebral blood flow Cerebral blood volume Computed tomography perfusion Computed tomography technologist Intra-class correlation coefficient Middle cerebral artery Mean transit time Region of interest Singular value decomposition Transient ischemic attack Time to peak Venous output function
Eur Radiol
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