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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleNeurovascular/Stroke Imaging

A Comparison of CT Perfusion Output of RapidAI and Viz.ai Software in the Evaluation of Acute Ischemic Stroke

Saif Bushnaq, Ameer E. Hassan, Adam Delora, Ali Kerro, Anita Datta, Rime Ezzeldin, Zuhair Ali, Tunmi Anwoju, Layla Nejad, Rene Silva, Yazan Diya Abualnadi, Zorain Mustafa Khalil and Mohamad Ezzeldin
American Journal of Neuroradiology July 2024, 45 (7) 863-870; DOI: https://doi.org/10.3174/ajnr.A8196
Saif Bushnaq
aFrom the Department of Neurology (S.B.), Texas Tech University Health Sciences Center, Lubbock, Texas
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Ameer E. Hassan
bDepartment of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
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  • ORCID record for Ameer E. Hassan
Adam Delora
cDepartment of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
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Ali Kerro
dDepartment of Neurology (A.K.), HCA Houston Healthcare Conroe, Conroe, Texas
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Anita Datta
cDepartment of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
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Rime Ezzeldin
eJordan University of Science and Technology (R.E.), Irbid, Jordan
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Zuhair Ali
cDepartment of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
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Tunmi Anwoju
cDepartment of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
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Layla Nejad
bDepartment of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
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Rene Silva
bDepartment of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
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Yazan Diya Abualnadi
bDepartment of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
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Zorain Mustafa Khalil
bDepartment of Neurology (A.E.H.), Valley Baptist Medical Center Harlingen (L.N., R.S., Y.D.A., Z.M.K.), Harlingten, Texas
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Mohamad Ezzeldin
cDepartment of Emergency Medicine (A. Delora, A. Datta), Clinical Sciences (Z.A., T.A.), and Neuroendovascular Surgery (M.E.), HCA Houston Healthcare Kingwood, Kingwood, Texas
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Abstract

BACKGROUND AND PURPOSE: Automated CTP postprocessing packages have been developed for managing acute ischemic stroke. These packages use image processing techniques to identify the ischemic core and penumbra. This study aimed to investigate the agreement of decision-making rules and output derived from RapidAI and Viz.ai software packages in early and late time windows and to identify predictors of inadequate quality CTP studies.

MATERIALS AND METHODS: One hundred twenty-nine patients with acute ischemic stroke who had CTP performed on presentation were analyzed by RapidAI and Viz.ai. Volumetric outputs were compared between packages by performing Spearman rank-order correlation and Wilcoxon signed-rank tests with subanalysis performed at early (<6 hours) and extended (>6 hours) time windows. The concordance of selecting patients on the basis of DAWN and DEFUSE 3 eligibility criteria was assessed using the McNemar test.

RESULTS: One hundred eight of 129 patients were found to have adequate-quality studies. Spearman rank-order correlation coefficients were calculated on time-to-maximum >6-second volume, time-to-maximum >10-second volume, CBF <30% volume, mismatch volume, and mismatch ratio between both software packages with correlation coefficients of 0.82, 0.65, 0.77, 0.78, 0.59, respectively. The Wilcoxon signed-rank test was also performed on time-to-maximum >6-second volume, time-to-maximum >10-second volume, CBF <30% volume, mismatch volume, and mismatch ratio with P values of .30, .016, <.001, .03, <.001, respectively. In a 1-sided test, CBF <30% was greater in Viz.ai (P < .001). Although this finding resulted in statistically significant differences, it did not cause clinically significant differences when applied to the DAWN and DEFUSE 3 criteria. A lower ejection fraction predicted an inadequate study in both software packages (P = .018; 95% CI, 0.01–0.113) and (P = .024; 95% CI, 0.008–0.109) for RapidAI and Viz.ai, respectively.

CONCLUSIONS: Penumbra and infarct core predictions between Rapid and Viz.ai correlated but were statistically different and resulted in equivalent triage using DAWN and DEFUSE3 criteria. Viz.ai predicted higher ischemic core volumes than RapidAI. Viz.ai predicted lower combined core and penumbra values than RapidAI at lower volumes and higher estimates than RapidAI at higher volumes. Clinicians should be cautious when using different software packages for clinical decision-making.

ABBREVIATIONS:

AIS
acute ischemic stroke
EF
ejection fraction
EVT
endovascular treatment
LVO
large-vessel occlusion
LKW
last known well
Tmax
time-to-maximum peak
  • © 2024 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 45 (7)
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Vol. 45, Issue 7
1 Jul 2024
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Cite this article
Saif Bushnaq, Ameer E. Hassan, Adam Delora, Ali Kerro, Anita Datta, Rime Ezzeldin, Zuhair Ali, Tunmi Anwoju, Layla Nejad, Rene Silva, Yazan Diya Abualnadi, Zorain Mustafa Khalil, Mohamad Ezzeldin
A Comparison of CT Perfusion Output of RapidAI and Viz.ai Software in the Evaluation of Acute Ischemic Stroke
American Journal of Neuroradiology Jul 2024, 45 (7) 863-870; DOI: 10.3174/ajnr.A8196

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CTP: RapidAI vs. Viz.ai in Ischemic Stroke
Saif Bushnaq, Ameer E. Hassan, Adam Delora, Ali Kerro, Anita Datta, Rime Ezzeldin, Zuhair Ali, Tunmi Anwoju, Layla Nejad, Rene Silva, Yazan Diya Abualnadi, Zorain Mustafa Khalil, Mohamad Ezzeldin
American Journal of Neuroradiology Jul 2024, 45 (7) 863-870; DOI: 10.3174/ajnr.A8196
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