ORIGINAL RESEARCH article
Front. Neuroimaging
Sec. Clinical Neuroimaging
Volume 4 - 2025 | doi: 10.3389/fnimg.2025.1613078
This article is part of the Research TopicAdvances in PET-CT ImagingView all 15 articles
Assessing the Accuracy of Automated CT Perfusion Software in Excluding Acute Stroke: A Comparative Study of Two Software Packages
Provisionally accepted
- 1Charité University Medicine Berlin, Berlin, Germany
- 2Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
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Background: Computed tomography perfusion (CTP) is frequently used for rapid assessment of suspected acute ischemic stroke (AIS). However, small lacunar infarcts often remain undetected by automated software, leading to false negatives and additional imaging. We compared the specificity of two commonly used CTP software packages in patients without stroke on follow-up diffusion-weighted imaging (DWI). Methods: In this single-center, retrospective study, 58 consecutive patients with suspected AIS but negative follow-up DWI MRI were included. All underwent CTP on the same scanner. Perfusion data were processed using (1) syngo.via (Siemens Healthcare) with three parameter settings—A (CBV <1.2 ml/100 ml), B (additional smoothing filter), C (rCBF <30%)—and (2) Cercare Medical Neurosuite (CMN). Software-reported ischemic core volumes were compared against MRI findings. Results: CMN showed the highest specificity, indicating zero infarct volume in 57/58 patients (98.3%). Conversely, all three syngo.via settings produced false-positive ischemic cores, with median volumes from 21.3 ml (setting C) to 92.1 ml (setting A). Only syngo.via setting C reported zero infarct volume in some patients, yet still showed substantial overestimation (maximum 207.9 ml). Conclusion: Our findings underscore significant variability in the ability of different CTP software to reliably rule out small (lacunar) infarcts. CMN demonstrated a good specificity, suggesting that dependable CTP-based stroke exclusion is achievable with advanced post-processing. High specificity could reduce reliance on follow-up MRI in acute stroke pathways if validated, improving resource allocation and patient throughput.
Keywords: Computed tomography perfusion, Acute ischemic stroke, Diagnostic accuracy, Lacunar infarct, Neuroimaging
Received: 16 Apr 2025; Accepted: 15 Sep 2025.
Copyright: © 2025 Thormann, Faltass, Schwab, Klebingat and Behme. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Maximilian Thormann, maximilian.thormann@charite.de
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