Visual versus automated CT perfusion for outcome prediction in anterior circulation stroke treated with mechanical thrombectomy
By: Igor Rigler, Tina Gspan, Alja Longo and Janja Pretnar Oblak
References
- Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018; 378: 708-18. doi: 10.1056/NEJMoa1713973
- Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018; 378: 11-21. doi: 10.1056/NEJMoa1706442
- Ma H, Campbell BCV, Parsons MW, Churilov L, Levi CR, Hsu CY, et al. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. N Engl J Med 2019; 380: 1795803. doi: 10.1056/NEJMoa1813046
- Yoshimura S, Sakai N, Yamagami H, Uchida K, Beppu M, Toyoda K, et al. Endovascular therapy for acute stroke with a large ischemic core. N Engl J Med 2022; 386: 1303-13. doi: 10.1056/NEJMoa2118191
- Sarraj A, Hassan AE, Savitz SI, Grotta JC, Cai C, Parsha KN, et al. Endovascular thrombectomy for large ischemic strokes. N Engl J Med 2023; 388: 1259-71. doi: 10.1056/NEJMoa2214403
- Huo X, Ma G, Tong X, Zhang X, Pan Y, Nguyen TN, et al. Endovascular therapy for acute ischemic stroke with a large infarct core. N Engl J Med 2023; 388: 359-70. doi: 10.1056/NEJMoa2213379
- Hoving JW, Marquering HA, Majoie CBLM, Yassi N, Sprengers MES, Berkhemer OA, et al. Accuracy of CT perfusion ischemic core volume and location estimation: comparison of four core estimation approaches using syngo.via VB40. PLoS One 2022; 17: e0272276. doi: 10.1371/journal.pone.0272276
- Muehlen I, Kloska SP, Almekhlafi MA, Bendszus M, Möhlenbruch MA, Pham M, et al. Comparison of two automated CT perfusion software packages (syngo.via vs RAPID) for ischemic core indication and clinical impact. Stroke 2022; 53: 1657-64. doi: 10.1161/STROKEAHA.121.036314
- Suomalainen OP, Martinez-Majander N, Sibolt G, Curtze S, Putaala J, Tatlisumak T, et al. Comparative analysis of core and perfusion lesion volumes between commercially available computed tomography perfusion software. Eur Stroke J 2023; 8: 259-67. doi: 10.1177/23969873221139416
- Koopman MS, van der Worp HB, Berkhemer OA, Fransen PSS, Beumer D, van Oostenbrugge RJ, et al. Comparison of three commonly used CT perfusion software packages in acute ischemic stroke patients. J Neurointerv Surg 2019; 11: 1249-56. doi: 10.1136/neurintsurg-2019-014822
- Meagher R, Shankar JJS. CT perfusion in acute stroke: black holes on time-to-peak image maps indicate unsalvageable brain. J Neuroimaging 2016; 26: 605-11. doi: 10.1111/jon.12336
- Rigler I, Gspan T, Avsenik J, Milosevic Z, Pretnar Oblak J. Independent significance of visual assessment of perfusion CT maps in anterior circulation stroke patients treated with mechanical thrombectomy. Clin Neuroradiol 2022; 32: 829-37. doi: 10.1007/s00062-021-01115-6
- Maas MB, Lev MH, Ay H, Singhal AB, Greer DM, Smith WS, et al. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke 2009; 40: 3001-5. doi: 10.1161/STROKEAHA.109.552513
- Psychogios MN, Sporns PB, Ospel J, Schregel K, Zoubi T, Behme D, et al. Automated perfusion calculations versus visual scoring of collaterals and CBV-ASPECTS: has the machine surpassed the eye? Clin Neuroradiol 2021; 31: 499-506. doi: 10.1007/s00062-020-00934-3
- Austein F, Riedel C, Kerby T, Meyne J, Binder A, Lindner T, et al. Comparison of perfusion CT software to predict the final infarct volume after thrombectomy. Stroke 2016; 47: 2311-7. doi: 10.1161/STROKEAHA.116.013147
- Yang W, Hoving JW, Koopman MS, Dankbaar JW, van der Schaaf IC, Niesten JM, et al. Agreement between estimated computed tomography perfusion ischemic core and follow-up infarct on diffusion-weighted imaging. Insights Imaging 2022; 13: 191. doi: 10.1186/s13244-022-01311-8
- Bang OY, Goyal M, Liebeskind DS. Collateral circulation in ischemic stroke: assessment tools and therapeutic strategies. Stroke 2015; 46: 3302-9. doi: 10.1161/STROKEAHA.115.010508
- Robben D, Boers AMM, Marquering HA, Berkhemer OA, Yoo AJ, van der Lugt A, et al. Prediction of final infarct volume from native CT perfusion and treatment parameters using deep learning. Med Image Anal 2020; 59: 101589. doi: 10.1016/j.media.2019.101589
Language: English
Submitted on: Mar 3, 2026
Accepted on: Apr 18, 2026
Published on: Jul 29, 2026
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
Related subjects:
© 2026 Igor Rigler, Tina Gspan, Alja Longo, Janja Pretnar Oblak, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.