{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:58:27Z","timestamp":1785322707153,"version":"3.55.0"},"reference-count":18,"publisher":"Walter de Gruyter GmbH","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic value of simple visual assessment of CT perfusion (CTP) for predicting clinical outcomes has already been demonstrated in stroke patients undergoing mechanical thrombectomy (MT). Automated software, however, has become the dominant method of CTP evaluation. The aim of the study was to compare the prognostic accuracy of visually graded CTP maps with automated CTP analysis on clinical outcomes in anterior circulation stroke patients treated with MT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>In the single centre we retrospectively analysed consecutive patients with anterior circulation large-vessel occlusion treated with MT. Baseline imaging included non-contrast brain CT, CT angiography (CTA) with collateral status (CS) and CTP. Time to peak (TTP) maps were visually graded on a four-level ordinal scale based on estimated penumbra. Automated CTP was processed with syngo.via (SYV) using default thresholds and classified on a comparable ordinal scale. The primary endpoint was favourable 90-day functional outcome (Rankin Scale (mRS) \u2264 3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 579 patients. Agreement between visual and automated CTP was fair (\u03ba = 0.36). Both methods were significantly associated with favourable outcome (p &lt; 0.01), with visual grading showing a slightly stronger association (Pearson \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      = 30 vs. 22). In multivariable models, visual CTP remained an independent predictor, whereas automated CTP lost significance when CS was included.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Visual CTP grading provided a slightly better prognostic performance than automated CTP. Visual CTP assessment is a simple, accessible and clinically meaningful tool for both treatment decision making and outcome prediction in anterior circulation stroke treated with MT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2478\/raon-2026-0039","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T09:01:56Z","timestamp":1785315716000},"source":"Crossref","is-referenced-by-count":0,"title":["Visual versus automated CT perfusion for outcome prediction in anterior circulation stroke treated with mechanical thrombectomy"],"prefix":"10.2478","author":[{"given":"Igor","family":"Rigler","sequence":"first","affiliation":[{"name":"Clinical Department of Vascular and Intensive Neurology Therapy, Neurology Clinic, University Medical Centre Ljubljana , Ljubljana , Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Gspan","sequence":"additional","affiliation":[{"name":"Clinical Department of Vascular and Intensive Neurology Therapy, Neurology Clinic, University Medical Centre Ljubljana , Ljubljana , Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alja","family":"Longo","sequence":"additional","affiliation":[{"name":"Clinical Institute of Radiology, Institute of Neuroradiology, University Medical Centre Ljubljana , Ljubljana , Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janja Pretnar","family":"Oblak","sequence":"additional","affiliation":[{"name":"Clinical Department of Vascular and Intensive Neurology Therapy, Neurology Clinic, University Medical Centre Ljubljana , Ljubljana , Slovenia"},{"name":"Department of Neurology, Faculty of Medicine, University of Ljubljana , Ljubljana , Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"2026072909590453967_j_raon-2026-0039_ref_001","doi-asserted-by":"crossref","unstructured":"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","DOI":"10.1056\/NEJMoa1713973"},{"key":"2026072909590453967_j_raon-2026-0039_ref_002","doi-asserted-by":"crossref","unstructured":"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","DOI":"10.1056\/NEJMoa1706442"},{"key":"2026072909590453967_j_raon-2026-0039_ref_003","doi-asserted-by":"crossref","unstructured":"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. 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N Engl J Med 2023; 388: 359-70. doi: 10.1056\/NEJMoa2213379","DOI":"10.1056\/NEJMoa2213379"},{"key":"2026072909590453967_j_raon-2026-0039_ref_007","doi-asserted-by":"crossref","unstructured":"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","DOI":"10.1371\/journal.pone.0272276"},{"key":"2026072909590453967_j_raon-2026-0039_ref_008","unstructured":"Muehlen I, Kloska SP, Almekhlafi MA, Bendszus M, M\u00f6hlenbruch MA, Pham M, et al. Comparison of two automated CT perfusion software packages (syngo.via vs RAPID) for ischemic core indication and clinical impact. 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