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Comparative Study
. 2009 Jul;51(7):445-51.
doi: 10.1007/s00234-009-0516-9. Epub 2009 Mar 10.

Automated versus manual post-processing of perfusion-CT data in patients with acute cerebral ischemia: influence on interobserver variability

Bruno P Soares  1 , Jan Willem Dankbaar, Joerg Bredno, SuChun Cheng, Sumail Bhogal, William P Dillon, Max Wintermark
Affiliations
Free PMC article
Comparative Study

Automated versus manual post-processing of perfusion-CT data in patients with acute cerebral ischemia: influence on interobserver variability

Bruno P Soares et al. Neuroradiology. 2009 Jul.
Free PMC article

Abstract

Introduction: The purpose of this study is to compare the variability of PCT results obtained by automatic selection of the arterial input function (AIF), venous output function (VOF) and symmetry axis versus manual selection.

Methods: Imaging data from 30 PCT studies obtained as part of standard clinical stroke care at our institution in patients with suspected acute hemispheric ischemic stroke were retrospectively reviewed. Two observers performed the post-processing of 30 CTP datasets. Each observer processed the data twice, the first time employing manual selection of AIF, VOF and symmetry axis, and a second time using automated selection of these same parameters, with the user being allowed to adjust them whenever deemed appropriate. The volumes of infarct core and of total perfusion defect were recorded. The cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and blood-brain barrier permeability (BBBP) values in standardized regions of interest were recorded. Interobserver variability was quantified using the Bland and Altman's approach.

Results: Automated post-processing yielded lower coefficients of variation for the volume of the infarct core and the volume of the total perfusion defect (15.7% and 5.8%, respectively) compared to manual post-processing (31.0% and 12.2%, respectively). Automated post-processing yielded lower coefficients of variation for PCT values (11.3% for CBV, 9.7% for CBF, and 9.5% for MTT) compared to manual post-processing (23.7% for CBV, 32.8% for CBF, and 16.7% for MTT).

Conclusion: Automated post-processing of PCT data improves interobserver agreement in measurements of CBV, CBF and MTT, as well as volume of infarct core and penumbra.

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Figures

Fig. 1
Fig. 1
Axial PCT map depicting the area of infarct core (red) and tissue at risk (green) in the right MCA territory. Also demonstrated are the regions of interest (ROIs) that were systematically drawn for all post-processing rounds in the MCA territory of the ischemic (yellow) and contralateral hemisphere (blue). Mean values of CBV, CBF and MTT measured in these ROIs were recorded
See this image and copyright information in PMC

References

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