Comparison of two automated compute tomography perfusion analysis packages in stroke patients within 24 hours of onset

Background: The analysis of computed tomography perfusion (CTP) scans plays a pivotal role in the diagnosis and management of acute ischemic stroke, aiding in extending the treatment window for endovascular therapy (EVT). This study aims to compare the ischemic core and hypoperfused tissue volumes estimated by JBS-10K, a newly developed automated CTP analysis packages, and RAPID. Method: This retrospective study analyzed data from 327 patients admitted to a single stroke center in Korea from January 2021 to May 2023, who underwent CTP scans within 24 hours of symptom onset. The concordance correlation coefficient and Bland-Altman plots were utilized to compare ischemic core volumes and hypoperfused lesion volumes between the software packages. Agreement with early (within 3 hours from CTP) follow-up infarct volumes on diffusion-weighted imaging (DWI, n = 217) was also evaluated. Results: The mean age was 70.7 (SD 13.0) and 137 (41.9%) were female. Ischemic core volumes by JBS-10K and RAPID in the threshold of relative cerebral blood flow (rCBF) < 30% had excellent agreement (ρ = 0.845 [95% CI, 0.811 to 0.874]). Excellent agreement was observed for time to maximum of the residue function (Tmax) > 6 seconds between JBS-10K and RAPID (ρ = 0.835 [95% CI, 0.806 to 0.863]). Although early follow-up infarct volume showed substantial agreement in both packages (JBS-10K ρ = 0.751 and RAPID ρ = 0.632), ischemic core volumes at the threshold of rCBF <30% tended to overestimate ischemic core volumes. Conclusion: CTP analysis using JBS-10K and RAPID demonstrated excellent agreement each other in patients undergoing CTP within 24 hours of symptom onset. ### Competing Interest Statement Sue young Ha, Gihoon Park, Jong-Hyeok Park, Dongmin Kim, and Wi-Sun Ryu are employee of JLK Inc. (Seoul, Republic of Korea). ### Funding Statement This study was supported by the Multiministry Grant for Medical Device Development (KMDF\_PR\_20200901_0098). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was approved by the institutional review board of Seoul National University Bundang hospital I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.